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THE  THERAPEUTICS  of  RADIANT 

LIGHT  AND  HEAT/  AND 

CONVECTIVE  HEAT 


WILLIAM  BENHAM  SNOW,   M.D. 

Author  of  "A    Manual  on  Electro-Static  Modes  of  Application, 

Therapeutics,  Radiography,  and  Radiotherapy  "  and  "  Currents 

of  High   Potential  of  High    and  Other   Frequencies "; 

Editor  of  the  Journal  of  Advanced  Therapeutics; 

and  late  Instructor  in  Electro -Therapeutics   in 

the   Nero    York  Post-Graduate  School,    etc. 


NEW  YORK 

SCIENTIFIC  AUTHORS'  PUBLISHING  CO. 
1909 


COPYRIGHT,  1909, 

BY 
WILLIAM  BENHAM   SNOW,   M.D. 


TO 

MY  MOTHER 


The  noblest  thoughts  my  soul  can  claim, 
The  holiest  words  my  tongue  can  frame, 
Unworthy  are  to  praise  the  name 
More  sacred  than  all  other. 

GEORGE   GRIFFITH    FETTER 


PREFACE 

AT  the  request  of  students  and  other  members  of  the 
profession  for  a  condensed  manual  on  the  employment  of 
radiant  light  and  heat,  the  writer  has  been  induced  to  prepare 
the  following  chapters. 

In  considering  the  subject,  attention  has  been  devoted  to 
the  elucidation  of  the  physiological  actions,  practical  indica- 
tions, and  methods  of  employing  radiant  light  and  heat  from 
the  modern  point  of  view. 

It  will  be  found  by  investigators  that  there  is  much  to  be 
derived  from  the  scientific  employment  of  these  measures  in 
therapeutics;  and  that  the  field  of  indication  is  much  greater 
than  the  rank  and  file  of  the  profession  are  aware  of. 

A  chapter  has  been  included  on  the  relative  action  of  radiant 
light  and  heat  and  the  Roentgen  ray,  a  subject  of  great 
importance  in  radiotherapy. 

Four  chapters  have  been  added  on  the  employment  of  con- 
vective  heat,  as  showing  the  contrast  and  similarity  of  action 
from  the  employment  of  the  two  forms  of  heat — radiant  and 
convective. 

It  has  been  the  writer's  purpose  in  the  preparation  of  this 
little  volume,  as  far  as  possible,  to  make  it  a  practical  aid  to 
beginners  in  an  important  department  of  physical  therapeutics, 
in  which,  if  he  has  succeeded,  he  will  be  rewarded  for  his 
efforts. 

WILLIAM  BENHAM  SNOW. 


CONTENTS 

SECTION  I 

RADIANT  LIGHT  AND  HEAT 
CHAPTER  I 

INTRODUCTION 15-24 

General  Consideration  of  Radiant  Energy  and  Its  Properties 
— Radiant  Light  and  Heat  and  Variations  as  Regards  Wave 
Length — Physical  Characteristics  of  Radiant  Energy — Refrac- 
tion of  Radiant  Energy — Reflection  of  Radiant  Energy — Polar- 
ization of  Light — Fluorescence  of  Various  Substances — The 
Manifestations  of  Color — Physical  Properties  of  Light — Effects 
of  Light  Upon  the  Chemical  Processes  of  the  Body — Tanning 
of  the  Skin — Hyperemia  as  Induced  by  Radiant  Energy. 

CHAPTER  II 

SOURCES  OF  RADIANT  ENERGY 25-39 

Natural  Sources — Artificial  Sources — The  Electric  Arc — The 
Incandescent  Light — The  Mercury  Vapor  Lamp — The  Actino- 
lite — The  Solar  Arc  Lamp — The  Finsen  Apparatus — Electric 
Incandescent  Lamps — The  Minin  Light — Small  Lamp — Light 
Bath  Cabinets — Construction  of  Light  Bath  Cabinets — In- 
candescent Bath  Cabinets — Arc  Light  Cabinets — Special  Types 
of  Light  Bath  Cabinets. 


CHAPTER  III 

PHYSIOLOGICAL  EFFECTS  OF  RADIANT  LIGHT  AND  HEAT  .  .  .  40-43 
Comparison  of  Forms  of  Radiant  Energy — Local  Influences  of 
Radiant  Light  and  Heat — Hyperemia  as  Induced  by  Radiant 
Light  and  Heat — Effects  Upon  Metabolism — Effects  Upon  Sim- 
ple Inflammation — Effects  in  Acute  and  Subacute  Infectious 
Conditions — Derivative  Effects  of  Radiant  Light  and  Heat. 


CHAPTER  IV 

PRACTICAL  METHODS  OF  APPLICATION  OF  RADIANT  LIGHT  AND  HEAT  44-^ 
Local  Administrations  of  Light — The  Induction  of  Hyperemia 
by  Ultra-Violet  Radiations — The  Choice  of  Lamps — Applica- 
tions to  Circumscribed  Areas — General  or  Constitutional  Treat- 
ment— Method  of  Local  Administration — Duration  of  Appli- 
cation— Finsen  Method  of  Application — General  Treatment 
with  High  Candle  Power  Incandescent  Lamp — The  Light  Bath, 
Duration,  and  After  Treatment — Mechanical  Vibration  after 
Treatment — Light  Baths  by  High  Candle  Power  Incandescent 
Lamps. 


8  CONTENTS 

CHAPTER  V 

TREATMENT  OF  SIMPLE  INFLAMMATION 49-52 

General  Consideration — Relief  of  Pain  by  Radiant  Light  and 
Heat — Post-Operative  Use  of  Radiant  Light  and  Heat — 
Method  of  Treatment  of  Simple  Inflammation — Treatment  of 
Myalgias — Treatment  of  Muscular  Soreness — Treatment  of 
Lumbago. 

CHAPTER  VI 

RADIANT  ENERGY  IN  THE  TREATMENT  OF  INFECTION  ....  53-63 
Bier's  Method — Specialized  Employment  'of  Radiant  Energy — 
Action  of  the  Roentgen  Ray  on  Germ  Life — Actions  of  Radiant 
Light  and  Heat  on  Germ  Processes — High  Frequency  Currents 
in  the  Treatment  of  Infectious  Conditions — Treatment  of  Cys- 
titis— Treatment  of  Otitis  Media — Treatment  of  Chronic  Otitis 
Media — Treatment  of  Mastoiditis — Treatment  of  Tubercular 
Arthritis — Treatment  of  Tubercular  Adenitis — Treatment  of 
Phlebitis — Treatment  of  Pelvic  Congestion — Treatment  of 
Ozena — Treatment  of  Post-Operative  Iritis. 


CHAPTER  VII 

RADIANT  ENERGY  IN  DERMATOLOGY 64-73 

Atonic  Conditions — Varicose  Ulcers — Supportive  Treatment  of 
Varicose  Ulcers — Treatment  of  Suppurating  Ulcers — Reports 
by  Various  Authorities  on  Dermatology — Treatment  of  Eczema 
— Treatment  of  Moist  Eczema — The  Use  of  the  Iron  Electrode 
Arc  Lamp  in  Various  Conditions. 


CHAPTER  VIII 

RADIANT    LIGHT    AND    HEAT   IN    CONDITIONS    ASSOCIATED   WITH 

FAULTY  METABOLISM 74-79 

Actions  on  the  Blood — Action  on  the  Superficial  End  Organs 
— Action  on  the  Deep  Spinal  Centers — Effects  of  General  Dif- 
fusion of  Heat — The  Actinic  and  Thermic  Action  of  Radiant 
Light — The  Induction  of  Superficial  Hyperemia — The  Stimu- 
lation of  Increased  .Elimination — Radiant  Light  and  Heat  in 
Nephritis — Radiant  Light  and  Heat  in  Infectious  Arthritis — 
Radiant  Light  and  Heat  in  Arteriosclerosis — Effects  of  the  Ra- 
diant Light  Bath — Treatment  of  Arteriosclerosis. 


CHAPTER  IX 

OPPOSITE  EFFECTS  OF  RADIANT  LIGHT  AND  HEAT  AND  THE  ROENTGEN 

RAY 80-90 

General  Observations — Physical  Characteristics  of  the  Roent- 
gen Ray — Stimulating  or  Tonic  Effects  of  the  Roentgen  Ray — 
Effects  of  the  Roentgen  Ray  on  Animal  Tissue — Experiments 
of  Dr.  Edward  C.  Titus  with  Light  and  the  X-ray — Conclu- 
sions on  the  Relative  Actions  of  the  X-ray  and  Radiant  Light 
and  Heat. 


CONTENTS  9 

SECTION  II 

CONVECTIVE  HEAT 

CHAPTER  I 

COMPARISON  OF  CONVECTIVE  HEAT  AND  RADIANT  HEAT      .       .       .  93-95 
Application  of  Dry  Heat — Means  of  Applying  Moist  Heat — 
The  Method  of  Using  Moist  Heat. 


CHAPTER  II 

PSYSIOLOGICAL   ACTIONS   OF   CONVECTIVE   HEAT 95"99 

Local  Applications  of  Convective  Heat — Observations  on  the 
Investigations  of  Dr.  T.  Addis  Emmett— The  Actions  of  Local 
Dry  Heat. 

CHAPTER  III 

THE  ADMINISTRATION  OF  DRY  AND  MOIST  HEAT    ....     100-103 
The  Poultice— The  Hot  Water  Bag— The  Russian  Bath— The 
Hot  Water  Bath— The  Hot  Douche— The  Employment  of  the 
Local    and    Body    Hot-Air    Apparatus — The    Hot    Box — The 
Turkish  Bath. 

CHAPTER  IV 

THERAPEUTICS  OF  CONVECTIVE  HEAT 104-110 

Treatment  of  Early  Quinsy  and  Suppurating  Tonsilitis — Treat- 
ment of  Felons  and  Whitlows — Early  Stage  of  Mastoiditis — 
Treatment  of  Mastoiditis — Treatment  of  Otitis  Media — Treat- 
ment of  Inflammatory  Conditions  of  the  Pleural  and  Abdominal 
Cavities — Treatment  of  Pleurisy — Treatment  of  Peritonitis — 
Treatment  of  Appendicitis — Employment  of  Local  Hot-Air 
Apparatus  in  Pleural  and  Abdominal  Cavities — Method  of 
Jointly  Employing  Convective  Heat  and  Cold  Applications — 
In  Reverse  Peristalsis  and  Other  Conditions — Use  of  Hot 
Douches  for  Rectal  and  Colonic  Flushings — Use  of  Dry  Heat 
in  General  and  Local  Septic  Infection — Trea'tment  of  Localized 
Septicemia — Treatment  of  Deep-Seated  Congestions — Treat- 
ment of  Non-Infectious  Inflammatory  Conditions — Treatment 
of  Conditions  of  Defective  Metabolism. 


LIST    OF    ILLUSTRATIONS 
SECTION  I 

FIG.  PAGE 

i. — ILLUSTRATING  REFRACTION     .                    19 

2. — REFRACTION  OF  A  BEAM  OF  LIGHT  THROUGH  A  PRISM  ...  19 

3. — THE  ANGLES  OF  INCIDENCE  AND  REFLECTION 20 

4. — SHOWING  REFLECTIONS  IN  PARALLEL 20 

5. — INDICATING  THE  CROSSING  OF  CONVERGENT  RAYS    ....  20 

6. — MARINE  SEARCH  LIGHT 27 

7. — SOLAR  ARC  LAMP 28 

8. — LEUCODESCENT  LAMP 30 

9. — LEUOCODESCENT  SCREENS 31 

10. — SMALL  LAMPS 31 

ii. — VICTOR  SMALL  LAMP  AND  SCREEN 31 

12. — UVIOL  LAMP 33 

13. — AUTHOR'S  BATH  CABINET 36 

14. — BETZ  RECLINING  BATH  CABINET 37 

15. — KNY-SCHEERER  LIGHT  BATH  CABINET 38 


ii 


LIST   OF   PLATES 

OPPOSITE  PAGE 

PLATE  I. — AUTHOR'S  AND  ASSOCIATE'S  LARGEST  OPERATING  ROOM 

WITH  SCREENS  AND  CURTAINS  REMOVED    .       .       .    Frontispiece 
PLATE  II. — TREATMENT    WITH    SMALL   BATH    CABINET   AND   500 

CANDLE  POWER  LAMP 39 

PLATE  III. — METHOD   OF   TREATMENT    WITH    500    CANDLE  POWER 

LEUCODESCENT  LAMP 44 

PLATE  IV. — METHOD  OF  TREATMENT  WITH    1000  CANDLE  POWER 

MARINE  SEARCH  LIGHT   ARC  LIGHT    ..:....      46 
PLATE  V. — METHOD  OF  TREATMENT  WITH  THE  LONDON  HOSPITAL 

LAMP 67 

PLATE  VI. — RECLINING  LIGHT  BATH  AS  USED  BY  THE  AUTHOR  AND 

ASSOCIATE 76 

PLATE  VII. — LOCAL  BETZ  KNEE  JOINT  APPARATUS  AS  APPLIED     .      102 
PLATE  VIII. — TREATMENT  OF  LEG  AND  THIGH  WITH  LOCAL  BETZ 

DRY  HOT  AIR  APPARATUS 108 


SECTION    I 

RADIANT    LIGHT   AND    HEAT 


RADIANT    LIGHT    AND    HEAT 

CHAPTER  I 
RADIANT  LIGHT  AND  HEAT 

The  application  of  radiant  energy  to  the  treatment  of  dis- 
ease, has  received  no  little  attention  from  therapeutists  during 
the  last  decade.  More  earnest  study  and  investigation  of  the 
agents  which  have  always  been  recognized  as  essential  to  life, 
have  resulted  in  the  introduction  of  therapeutic  methods  which 
bid  fair  to  give  the  various  forms  of  radiant  energy  rank 
with  the  most  valuable  curative  agents.  Their  skillful  employ- 
ment is  fraught  with  little  danger.  To  effect  the  best  results 
however  in  the  large  class  of  cases  for  which  they  are  indicated, 
a  thorough  knowledge  of  the  requirements  and  limitations 
of  technique  is  indispensable. 

Radiant  energy  as  emitted  from  the  usual  sources  includes 
the  transmission  of  light,  heat,  the  Roentgen  ray  and  the 
emanations  from  radium  and  other  radio-active  substances 
through  the  medium  of  the  ether  and  air  which  are  capable  of 
setting  up  responsive  vibrations  in  animal  tissue.  The  effect 
of  the  various  rates  of  frequency  is  normally  to  induce  re- 
sponses of  the  organs  of  special  sense;  each  sense  having 
perception  of  a  wide  range  of  vibration  frequencies  during 
health.  The  pressure  sense  and  sense  of  hearing  respond  only 
to  vibrations  of  substantial  bodies  in  the  form  of  gases  or 
solids;  while  radiant  light  and  heat  are  transmitted  through 
the  ether  and  are  of  higher  frequency  and  shorter  wave  length, 
inducing  responses  relative  to  their  intensity — of  heat,  in  the 
terms  of  degrees,  and  of  light,  in  terms  of  color. 

The  higher  invisible  frequencies  are  manifested  only  by  the 
effects  on  living  tissue,  and  by  fluorescence  of  substances  in 
which  they  are  capable  of  setting  up  in  other  bodies  thus  ex- 
posed secondary  vibrations  corresponding  with  the  visible  light 
frequencies.  Platino-barium-cyanide  and  tungstate  of  calcium 
respond  to  the  ultra-violet  and  Roentgen  ray  frequencies  with 

15 


1 6  RADIANT  LIGHT  AND  HEAT 

a  clear,  nearly  white  fluorescence  and  willemite  with  green. 
The  higher  frequencies,  to  which  the  senses  do  not  perceptibly 
respond,  are  ether  vibrations  emanating  in  Nature  from  the 
sun  or  radio-active  substances  or  are  produced  from  high  volt 
electrical  sources  as  the  electric  arc,  and  the  Crookes  tube, 
evolving  from  the  former  all  of  the  frequencies  of  light,  and 
also  the  invisible  frequencies  at  either  end  of  the  spectrum 
— the  ultra  violet  and  infra-red  or  heat  frequencies,  and  from 
the  latter  the  various  frequencies  of  the  Roentgen  ray,  increas- 
ing as  they  do  in  frequency  with  shortening  of  wave  length 
as  the  vacuum  of  the  tube  becomes  higher. 

It  is  readily  appreciated  that  these  various  frequencies  of 
ether  vibration,  affecting  as  they  manifestly  do  human  tissue, 
induce  effects  relative  to  their  wave  lengths  and  frequency. 

When  it  is  recognized  that  "heat  is  an  energy  of  molecular 
motion  with  sudden  changes  of  direction  and  velocity,  when 
the  molecules  come  near  enough  to  one  another"  it  is  self- 
evident  that  the  human  body  at  98  2-5°  F.  is  a  mass  of  matter 
in  active  molecular  motion  responding  to  heat,  and  coincidently 
responding  to  the  influences  of  the  other  frequencies.  Made 
up  of  active  organic  parts  each  fulfilling  a  rhythm  of  its  own, 
particularly  the  thrill  of  the  cardiac  contractions  transmitted 
through  the  coats  of  the  arterial  walls  and  the  complexity  of 
the  vibrations  of  the  nervous  mechanism,  it  is  manifest  that 
when  those  functions  are  recognized  to  depend  more  or  less 
upon  external  sources  for  their  maintenance,  that  a  loss  of 
normal  rhythm,  or  lost  balance,  would  naturally  be  restored  by 
re-establishment  of  the  normal  rate  of  vibration  from  such 
sources. 

In  accord  with  the  law  of  harmonic  vibration,  it  is  prob- 
able that  the  tissues  attune  themselves  from  a  source  of  mixed 
vibrations,  as  of  the  combined  spectral  vibrations  of  radiant 
light  and  heat,  deriving  therefrom  by  selection  the  kind  of 
energy  which  sets  up  and  restores  functional  activity.  While 
this  is  true  of  the  light  and  heat  frequencies  which  are  a  part 
of  normal  living  environment,  the  higher  frequencies,  which 
are  not  essential  to  health  under  normal  conditions,  as  the 
radiations  of  the  Roentgen  ray  and  radium  emanations,  have 
a  tendency  to  overwhelm  the  tissues  exerting  abnormal  in- 
hibitory influences.  It  is  also  true  that  the  ether  vibrations 
which  constitute  a  normal  environment  do  under  extreme  con- 


RADIANT  LIGHT  AND  HEAT  17 

ditions,  as  of  prolonged  exposures  to  the  light  and  heat  radia- 
tions of  the  sun,  become  inhibitory  or  depressing  in  their  influ- 
ence upon  human  life.  Under  varying  conditions  it  will  then  be 
readily  appreciated  that  the  judicious  employment  of  the  wide 
range  of  vibratory  radiant  energy  will  be  in  a  large  measure 
capable  either  of  restoring  or  inhibiting  the  vibratory  energies 
or  activities  of  the  animal  organism. 

These  higher  frequencies  of  radiant  energy  conserve  the 
chemical  actions  and  the  more  gross  and  energetic  mechanical 
agencies,  as  certain  electrical  modalities,  mechanical  vibration 
and  exercise  conserve  the  mechanical  demands  for  relieving 
stasis  and  infiltration,  and  also  increasing  the  activity  of  the 
grosser  functions  of  the  organism. 

From  the  point  of  view  suggested  by  the  above  premises,  it 
will  be  recognized  that  the  study  of  the  application  of  these 
vibratory  agents  to  therapeutics  suggests  the  investigation  of 
the  principles  of  adaptation  of  external  vibratory  energy  to  the 
restoration  of  the  body,  properly  sustained,  to  its  normal  vibra- 
tion in  all  its  parts,  as  evidenced  by  the  revival  of  health  with 
the  restoration  of  functional  activities. 

It  must  always  be  recognized  that  while  external  agents 
exert  temporarily  the  energy  of  motion — vibration — a  sustain- 
ing pabulum  or  tissue  food  is  essential  to  its  maintenance. 
These  two — imparted  activity  and  nutrition  constitute  a  vis-a- 
tergo  leading  to  the  restoration  and  preservation  of  the  func- 
tional activities. 

Radiant  light  and  radiant  heat  from  the  same  general  char- 
acteristics, render  the  actions  of  the  spectral  and  infra-red 
or  heat  rays,  similar  in  their  effects  upon  living  tissue,  and 
as  they  are  emitted  together,  and  neither  is  contraindicated,  in- 
most cases  it  is  customary  to  treat  of  them  in  unison  as 
radiant  light  and  heat  radiations.  It  should  be  borne  in  mind 
that  the  incandescent  or  mercury  vapor  lamps  or  arc  lamps, 
employed  with  intervening  glass  screens  or  glass  lenses,  cut  out 
or  absorb  most,  if  not  all,  of  the  ultra-violet  frequencies. 
This,  however,  is  generally  desirable  because  during  courses  of 
light  treatment  with  the  ultra-violet  frequencies  included,  as 
when  employing  direct  sunlight  or  the  electric  arc,  the  skin 
soon  becomes  tanned ;  afterwards  largely  impeding  the  penetra- 
tion and  consequent  beneficial  action  of  all  of  the  light  fre- 
quencies. The  irritating  and  tanning  ultra-violet  frequencies 


1 8  RADIANT  LIGHT  AND  HEAT 

seem  therefore  to  be  a  provision  of  Nature  for  protection 
against  overstimulation  of  the  deeper  tissues  of  those  who  are 
much  exposed  to  the  sun's  rays,  in  the  tropics  and  during  the 
summer  in  the  temperate  zones. 

Radiant  light  and  heat  are  usually  derived  from  the  same 
sources  and  constitute  "a  form  of  wave  motion  projected  by 
the  wave  motion  of  the  luminiferous  ether,"  and  differ  only  in 
kind,  being  capable  of  conversion  one  into  the  other,  as  light 
passed  through  an  object  which  absorbs  a  part  of  the  frequen- 
cies is  converted  into  heat  units, — as  demonstrated  in  the  pass- 
age of  light  through  blue  glass.  The  fact  that  they  are  radiated 
from  the  same  sources  and  differ  only  in  frequency  of  vibra- 
tion and  wave  lengths  with  the  objectionable  higher  frequen- 
cies cut  out  indicates  their  general  employment  in  unison. 

The  physical  characteristics  and  the  differences  in  those 
characteristics  as  exerted  by  the  various  frequencies,  may  be 
considered  with  reference  to  frequency  or  rate  of  vibration  and 
wave  length  as  affecting  (i)  penetration,  (2)  refraction,  (3) 
polarization,  (4)  fluorescence,  (5)  color,  and  (6)  heat  produc- 
tion; and  as  affecting  human  tissue,  (i)  inducing  hyperemia, 
(2)  producing  tanning,  (3)  superficial  and  deeper  effects  upon 
metabolism,  (4)  actinic  actions — affecting  oxidation  and  germ 
life,  and  (5)  reflex  effects  upon  functions  remote  from  the 
surface  through  the  end  neurons  and  nerve  connections. 

The  frequency  and  wave  length  of  the  radiations  of  light 
vary  from  45o,ooo,ooo,cxx)  per  second  of  red  to  850,000,000,- 
ooo  of  violet,  between  which  range  the  rates  of  the  other  fre- 
quencies. The  wave  length  shortens  relatively  as  the  frequency 
increases;  and  it  has  been  also  practically  demonstrated  that 
the  penetration  diminishes  with  the  wave  length.  In  other 
words,  the  infra-red  or  heat  radiations,  of  the  lower  frequen- 
cies of  light,  have  relatively  greater  power  of  penetration  than 
the  ultra-violet  and  higher  light  frequencies,  blue,  indigo  and 
violet.  This  rule  of  decrease  in  penetration  applies  with  in- 
crease of  the  angle  of  refraction  as  the  frequency  increases 
until,  as  Lodge  has  said,  "the  wave  lengths  are  found  that  are 
smaller  than  the  atoms,  when  they  go  straight  on,"  as  do  the 
x-rays. 

Refraction. — When  a  ray  or  beam  of  light  passes  between 
media  of  varying  densities,  it  is  bent  out  of  its  direction, 
both  at  the  entrance  to  the  denser  and  the  exit  into  the  rarer 


RADIANT  LIGHT  AND  HEAT 


media,  being  bent  at  an  angle  towards  the  perpendicular  let 
fall  to  the  plane  of  the  surface  in  the  first  instance,  and  from  it 
in  the  second,  Fig.  i.  It  is  by  refraction  through  a  prism  that 
white  light  is  resolved  into  the  prismatic  colors.  A  beam  of 
white  light  allowed  to  fall  upon  a  transparent  prism  is  divided 


Fig.  i. — Illustrating  Refraction. 

into  its  component  parts.  Beginning  with  the  more  refrangible, 
the  order  in  which  the  colors  occur  are  as  shown  in  Fig.  2; 
passing  from  the  violet  to  red,  with  the  varying  degrees  of 
refraction,  and  the  varying  colors  as  may  be  shown  by  throwing 


Fig.  2. — Showing  Refraction  of  a  Beam  of  Light  Passed  through  a  Prism,  and 
the  Order  of  the  Spectral  Colors. 

the  refracted  rays  upon  a  screen  in  a  darkened  room  or  as  seen 
in  the  rainbow. 

Reflection  is  the  property  of  light,  whereby  a  pencil  or  beam 
of  light  thrown  against  certain  surfaces  is  caused  to  be  re- 
flected backward  or  at  an  angle  according  to  the  obliquity  at 
which  the  rays  strike  the  reflecting  surface,  the  angle  of  in- 
cidence being  equal  to  the  angle  of  reflection;  i.  e.,  if  a  per- 


20 


RADIANT  LIGHT  AND  HEAT 


pendicular  be  drawn  or  let  fall  to  a  reflecting  surface,  the  angle 
formed  between  the  line  of  light  and  the  perpendicular  will  be 
equal  to  the  angle  between  the  opposite  side  of  the  perpen- 
dicular, and  the  line  of  the  reflected  radiation,  Fig.  3. 


Fig.  3. — Showing  Angle  of  Incidence  and  Angle  of  Reflection. 

The  laws  of  reflection  obtain  also  with  the  reflections  from 
concave  mirrors,  the  proximity  of  the  luminous  body  to  the 
reflecting  surface  varying  the  focal  points  of  the  radiation, 


Fig.  4. — Showing  Reflections  in  Parallel  and  Convergent  from  Concave  Mirror. 

Fig.  4 ;  or  when  placed  at  the  requisite  angle,  producing  parallel 
radiations  as  illustrated  in  the  accompanying  drawing.  An- 
other matter  for  particular  consideration  to  the  therapeutist  is 


Fig.  5. — Indicating  Crossing  of  Convergent  Rays  and  Dark  Spot  beyond, 
within  Which  Shimmer  Appears. 

the  fact  that  beyond  the  focal  point  where  the  rays  cross,  a 
ring  of  light  is  produced  surrounding  a  dark  center,  Fig.  5. 


RADIANT  LIGHT  AND  HEAT  21 

Within  this  light  ring  a  violet  shimmer  appears  which  will  mis- 
lead the  unsophisticated,  and  may  be  made  use  of  to  lead  phy- 
sicians unsuspectingly  to  believe  that  this  shimmer  is  the  violet 
or  ultra-violet  radiation,  which  is  quite  false.  It  should  always 
be  considered,  in  investigating  an  apparatus,  where  the  focal 
point  will  fall,  and  with  the  understanding  that,  except  imme- 
diately beyond  the  focal  point,  where  the  invisible  ultra-violet  is 
present,  the  rays  are  dispersed  in  such  a  manner  as  to  be  of 
little  use  for  therapeutic  purposes.  From  the  incandescent 
light,  with  parabolic  reflector,  the  point  of  greatest  intensity 
of  heat  would  be  at  about  the  focal  point,  the  degree  of  inten- 
sity diminishing  as  the  object  is  placed  nearer  to  the  reflecting 
surface. 

Polarisation,  as  of  interest  in  the  consideration  of  light,  con- 
sists of  a  double  refraction  that  occurs  when  light  passes 
through  certain  substances  as  Iceland  spar,  and  is  not  of  sig- 
nificance as  pertaining  to  therapeutics. 

Fluorescence,  as  induced  in  certain  substances,  is  a  second- 
ary effect  arising  from  the  projection  of  radiant  energy.  Some 
substances,  as  sulphide  of  calcium,  continue  to  fluoresce  for 
hours  after  prolonged  exposures  to  radiant  light.  Certain  sub- 
stances also  fluoresce  under  the  radiations  of  the  higher  invis- 
ible frequencies  of  radiant  energy  only,  as  the  fluorescence  of 
willemite,  tungstate  of  calcium,  and  platino-barium-cyanide  un- 
der exposures  of  ultra-violet  and  x-ray  radiations.  It  is  by 
this  property  of  light  and  matter  that  we  are  able  to  discern 
the  presence  of  the  invisible  frequencies. 

Color  is  the  manifestation  of  the  various  degrees  of  refran- 
gibility  of  the  spectral  rays  of  light, — the  radiations  that  con- 
stitute light.  Some  writers  of  recent  date  have  erred  in  the 
use  of  the  term  light,  applying  "x-light"  to  the  x-ray,  and 
"ultra-violet  light"  to  the  frequencies  above  the  violet ;  where- 
as, only  the  visible  frequencies  constitute  light.  The  ultra-vio- 
let, x-ray,  and  infra-red  are  the  invisible  frequencies  of  the 
spectrum,  and  are  discerned  only  through  the  means  of  fluores- 
cence, and  the  effects  upon  sensitized  plates,  with  the  higher 
frequencies,  and  by  the  thermopile  as  registering  the  radia- 
tions of  heat  with  the  lower  frequencies.  It  will  be  seen  that 
radiant  light  and  radiant  heat  are  very  closely  allied ;  the  lower 
frequencies  of  light,  the  red  and  orange,  containing  heat  radia- 
tions, as  evidenced  by  the  thermopile.  The  infra-red  or  heat 


22  RADIANT  LIGHT  AND  HEAT 

rays  have  their  maximum  heat  intensity  at  a  short  distance  from 
the  red ;  but  are  present  to  a  less  degree  at  a  distance  from  the 
red  about  equal  to  the  range  of  the  visible  spectrum  from  red 
to  violet.  The  higher  frequencies  of  the  ultra-violet  and  the 
x-ray  are  devoid  of  heat  radiations.  This  fact  readily  explains 
the  difference  of  the  temperature  of  incandescent  bulbs  trans- 
mitting the  red,  orange  and  white  light,  as  compared  with  the 
blue  or  violet  bulbs  in  which  the  lower  frequencies  are  ab- 
sorbed ;  the  heat  of  the  latter  becoming  markedly  more  intense 
under  radiations  employing  the  same  candle  power  than  the 
transparent  red  or  orange  incandescent  bulbs.  In  other 
words,  a  secondary  radiation  is  induced  from  the  glass  of  the 
violet  bulb  plus  the  infra-red,  radiations  from  the  conversion  of 
the  lower  frequencies  into  heat  by  absorption,  which  renders 
the  heat  radiated  of  greater  intensity  from  the  bulbs  of  blue  or 
violet. 

The  physical  properties  of  light  above  described  are  of  in- 
terest only  in  therapeutics,  as  defining  the  properties  of  the 
agents  employed,  the  principles  of  which  are  significant  and 
suggestive  as  to  the  effects  produced  upon  the  human  organism. 

The  effects  of  radiant  light  and  heat  upon  human  tissue  are 
complex  from  the  nature  of  things,  and  not  always  easy  of 
determination ;  as  the  processes  of  metabolism  are  so  difficult  of 
demonstration — the  building  processes  of  anabolism,  and  the 
taking  down  and  removal  of  effete  materials  of  katabolism. 
These  metabolic  processes,  dealing  with  the  appropriation  of  the 
nutrient  circulating  fluids,  and  combining  both  physical  and 
chemical  qualities,  indicate  the  necessity  of  incessant  activity, 
with  the  supply  of  the  necessary  pabulum  for  repair  relative 
to  the  activities  of  the  organism  as  a  whole,  or  the  part  of  the 
organism  in  question. 

If  light  and  heat  energy  are  necessary  to  the  carrying  out  of 
the  body's  normal  processes,  most  living  creatures  requiring 
light  and  heat  for  the  maintenance  of  health,  the  effects  are 
prerequisites. 

The  chemical  processes  of  the  human  body  in  a  state  of 
health,  without  exercise,  are  capable  of  supplying  the  requisite 
amount  of  heat  to  resist  only  moderate  degrees  of  cold,  requir- 
ing an  increased  chemical  action  and  tissue  combustion  for  the 
maintenance  of  the  normal  body  temperature  unless  a  sur- 
rounding temperature  approaching  60°  to  80°  F.  is  maintained, 


RADIANT  LIGHT  AND  HEAT  23 

otherwise  the  escape  of  body  heat  must  be  prevented  by  cloth- 
ing of  non-conducting  material  to  prevent  cooling  by  convec- 
tion. 

The  chemical  actions  of  light,  as  inducing  oxidation  and  ac- 
tinic effects,  are  irritating  and  destructive,  unfavorably  affect- 
ing certain  forms  of  germ  life,  and  for  this  reason  notably  of 
value  in  therapeutics. 

Tanning  of  the  skin,  by  the  effects  of  radiant  energy,  is  in- 
duced by  the  higher  frequencies,  particularly  by  the  invisible 
ultra-violet  radiations.  This  is  demonstrated  in  the  experience 
of  those  who  have  used  the  high  candle  power  incandescent 
lamps  and  light  baths,  when  numerous  prolonged  exposures, 
made  from  these  sources,  invariably  have  not  produced  tan- 
ning; whereas,  by  the  employment  of  the  arc  light,  or  the  arc 
light  bath,  or  by  the  localized  treatment  by  high  candle  power 
arc  lamps,  rich  in  the  higher  frequencies,  tanning  invariably 
results.  The  writer  has  verified  this  from  his  own  experience, 
and  from  this  fact  has  abandoned  the  use  of  the  arc  light  and 
ultra-violet  frequencies,  except  with  the  employment  of  inter- 
vening glass  screens,  in  the  treatment  of  conditions  in  which 
stimulating  and  metabolic  influences  of  the  penetrating  rays  are 
indicated. 

The  hyperemia  induced  by  the  action  of  these  frequencies 
which  is  associated  with  tanning,  is  very  superficial  but  painful 
in  its  effects,  in  many  cases  inducing  vesication  of  the  skin, 
and  therefore  except  when  such  effects  are  desirable,  is  con- 
tra-indicated. It  would  seem  that  the  main  object  in  nature,  so 
far  as  the  human  race  is  concerned,  of  the  ultra-violet  and 
higher  visible  frequencies,  is  to  effect  tanning  in  order  that 
white  races  living  in  the  tropics  or  during  the  summer  seasons 
in  temperate  zones,  who  are  much  exposed  to  the  sunlight,  may 
not  be  overstimulated  by  the  penetrating  action  of  the  stimula- 
ting rays  of  light  and  heat  of  the  lower  frequencies.  It  is  an 
undoubted  fact  that  in  the  course  of  centuries,  peoples  who  live 
constantly  in  these  climates  have  become  dark-skinned  races, 
as  is  notable  in  the  Spaniards,  Italians,  and  others  living  in  the 
tropics  or  southern  portion  of  the  north  temperate  zone. 

The  induction  of  hyperemia  by  the  actinic  effects  of  the 
higher  frequencies,  and  from  the  combined  action  of  all  the 
frequencies  of  light,  together  with  the  radiant  heat,  are  demon- 
strated to  be  capable  of  increasing  positive  chemotaxis,  hasten- 


24  RADIANT  LIGHT  AND  HEAT 

ing  the  destruction  and  release  of  the  tissues  from  deleterious 
substances,  or  forms  of  germ  life  present  in  them.  The  degrees 
to  which  this  may  be  effected  will  vary  with  the  character  of  the 
radiations  as  to  volume  and  intensity. 

The  effect  of  light  and  heat  radiations  upon  metabolism  is  to 
quicken  the  functional  activities  of  the  cells  thus  stimulated, 
promoting  elimination  through  activity  of  the  sweat  glands, 
and  inducing  an  increased  influx  of  blood  associated  with  the 
hyperemia  produced,  thereby  favoring  local  nutrition  and 
elimination.  The  application  of  intense  heat  and  light  to  the 
peripheral  neurons  undoubtedly  also  stimulates  reflexly  greater 
activities  in  parts  and  organs  remote  from  the  site  of  stimula- 
tion. This  is  clinically  demonstrated  in  the  beneficial  influence 
of  light  upon  tissue  building,  and  increased  body  weight,  prob- 
ably by  influences  both  anabolic  and  katabolic.  These  effects, 
in  a  general  way,  indicate  the  therapeutic  employment  of  light, 
and  place  it  in  the  field  as  one  of  the  valuable  physical  the- 
rapeutic measures. 


CHAPTER  II 
SOURCES  OF  RADIANT  ENERGY 

The  sources  of  radiant  energy  are  both  natural  and  artificial. 

The  natural  sources  are  the  sun,  radium,  uranium  and  other 
radio-active  bodies ;  the  sun  alone  in  connection  with  this  chap- 
ter calling  for  consideration. 

The  artificial  sources  are  the  electric  arc,  incandescent,  and 
mercury  vapor  lamps,  and  the  Crookes  tube,  all  electrical 
sources;  and  others  not  practical  for  therapeutic  purposes,  in- 
cluding all  flaming  or  burning  materials,  which  emit  radiant 
light  and  heat. 

/.  The  sun,  the  natural  source  of  light,  furnishes  all  that 
could  be  desired  when  employed  in  conjunction  with  surround- 
ing conditions  and  the  necessary  means  for  facilitating  conden- 
sation, direct  radiation,  and  in  connection  with  various  ar- 
rangements for  filtration  when  desirable. 

The  variations  in  weather  conditions  in  most  climates,  how- 
ever, render  it  as  a  source  of  radiant  energy  rather  too  capri- 
cious for  a  practical  means  in  therapeutics. 

II.  The  electrical  arc,  as  an  artificial  source  of  radiant  energy, 
has  been  employed  since  the  first  introduction  of  artificial  light 
in  therapeutics.  It  possesses  the  advantage,  especially  when 
generated  in  connection  with  iron  cored  electrodes,  of  evolving 
rays  particularly  rich  in  the  chemical  or  ultra-violet  end  of  the 
spectrum.  There  are  disadvantages  in  the  administration  how- 
ever, when  it  is  to  be  employed  for  the  general  or  constitutional 
effects  in  that  it  cannot  be  applied  directly  over  a  patient,  as 
when  resting  in  a  recumbent  position,  because  of  hot  flying 
particles  from  the  consuming  carbon  electrodes.  Another  dis- 
advantage is  that  the  relative  amount  of  current  consumed  in 
the  production  of  a  given  amount  of  radiant  light  and  heat  is 
much  greater  than  with  the  high  power  incandescent  lamp. 
In  the  enclosed  light  bath  employing  sufficient  candle  power  to 
produce  the  desired  radiant  light  and  heat  effects,  it  is  impos- 
sible for  some  patients,  and  all  patients  under  extreme  condi- 
tions of  time  and  intensity,  to  inhale  and  withstand  the  gases 

25 


26  RADIANT  LIGHT  AND  HEAT 

thrown  off  from  the  arc  lamps.  These  gases  are  composed 
largely  of  nitrous  acid  and  ozone,  evolved  by  the  electric  arc. 
Furthermore,  when  it  is  desired  to  produce  profound,  combined 
light  and  heat  effects,  for  a  long  period  of  time,  the  ultra-violet 
rays,  as  stated  in  the  previous  chapter,  induce  too  great  a  de- 
gree of  hyperemia  of  the  skin,  which  is  followed  by  marked 
tanning,  due  to  the  peculiar  action  of  the  higher  frequencies. 
However,  in  certain  cases,  the  induction  of  intense  hyper- 
emia may  be  desirable,  but  the  tanning  interferes  largely  with 
subsequent  beneficial  effects  when  it  is  desirable  to  continue 
administrations  of  radiant  energy  to  the  deeper  tissues.  For 
the  treatment  of  local  infectious  processes,  as  in  lupus  vulgaris, 
with  the  employment  of  intense  focused  light,  rich  in  ultra-vio- 
let, the  arc  light  is  indicated  in  some  cases. 

///.  The  incandescent  light  properly  fills  the  widest  field  of 
therapeutic  indication.  This  type  of  lamp  combines  a  large 
percentage  of  radiant  heat  which,  when  focused  or  from  lamps 
of  high  candle  power,  is  rich  in  luminous  rays — rays  which 
penetrate  deeper  into  the  tissues  than  the  radiations  of  the 
higher  frequencies  in  which  they  are  deficient.  A  light  of  this 
sort  is  always  most  convenient  of  application,  as  it  can  be  ap- 
plied directly  over  the  patient  while  reclining ;  with  the  advan- 
tage that  a  maximum  surface  is  receiving  the  radiations  while 
the  opposite  surface  is  not  exposed  during  the  administration. 
Another  advantage  is  that  the  light  may  be  moved  back  and 
forth  over  the  surface  with  the  greatest  convenience  and  by  the 
patient  himself  during  applications  to  the  front  of  the  body. 
Another  advantage  of  the  incandescent  light  is  that  it  jsjdepleted 
of  the  ultra-violet  radiations  and  may  therefore  be  applied,  if 
desirable,  for  a  longer  time  without  danger  of  producing  a  dis- 
agreeable hyperemia  or  eventually  tanning  the  surface  of  the 
skin,  thereby  interfering  with  the  maximum  degree  of  thera- 
peutic efficiency. 

IV.  The  mercury  vapor  lamps  have  been  employed  by  some 
for  general  applications  but  to  the  present  time  have  little 
recognized  therapeutic  value.  The  radiations  produced  by 
these  lamps  are  rich  in  the  higher  frequencies,  but  the  red  and 
infra-red  are  absent ;  and  as  the  ultra-violet  frequencies  are  fil- 
tered out  by  the  glass  in  passing,  they  possess  no  advan- 
tage over  the  incandescent  lamps,  but  a  decided  disadvantage  in 
that  the  red  and  heat  rays,  which  are  most  penetrating  and 


SOURCES  OF  RADIANT  ENERGY  27 

effective,  are  to  a  very  large  degree  absent  from  this  type  of 
light. 

There  have  been  several  types  of  arc  lamp  manufactured  and 
used  for  therapeutic  purposes. 

The  marine  search  light,  manufactured  by  Bogue  &  Co.,  of 
New  York,  is  provided  with  a  parabolic  reflector  and  movable 
carriage,  and  self-adjusting  device  for  maintaining  the  carbon 


Fig.  6. — Marine  Search  Light. 

electrodes  in  contact  (see  Fig.  6).  The  movable  or  adjustable 
platform  may  be  so  regulated  as  to  vary  the  divergence  or  con- 
vergence of  the  rays  whereby  either  parallel  rays  or  focused 
rays  may  be  projected  upon  the  patient.  The  author's  appara- 
tus has  also  been  provided  by  him  with  a  hood  and  water  cool- 
ing device,  whereby  the  rays  from  the  arc  may  be  focused  and 
emitted  through  plain  rock  crystal  lenses  for  use  for  the  treat- 
ment of  one  patient  instead  of  four  as  by  the  arrangement  of 
Niels  Finsen,  as  employed  for  the  treatment  of  lupus  or  other 
conditions  in  which  this  method  of  treatment  may  be  indicated. 
A  blue  glass  screen  is  also  provided  with  this  lamp. 


28 


RADIANT  LIGHT  AND  HEAT 


The  actinolite,  one  of  the  older  types  of  arc  lights,  focuses 
or  renders  the  radiations  parallel  or  divergent  by  means  of 
a  movable  glass  lens.  This  lamp  was  manufactured  by  Kliegl 
Bros.,  also  of  New  York,  and  is  of  varying  capacity.  It  pos- 
sesses the  same  disadvantages  as  the  other  arc  lamps  except 
that  the  light  being  passed  through  glass  lenses  the  ultra-violet 
radiations  are  cut  out  or  absorbed. 

Another  arc  recently  put  upon  the  market  by  Frank  S.  Betz, 
of  Chicago,  (Fig.  7)  is  practically  after  the  same  idea  as  the 


marine  search  light;  but 
uses  less  amperage,  pro- 
ducing less  light,  and  in- 
cludes colored  screens  for 
cutting  out  the  ultra-violet 
and  various  colors  of  the 
spectrum.  The  lamp  is  a 
very  practical  one  of  its 
kind  and  will  be  welcomed 
by  those  who  are  seeking  a 
low-priced  arc  lamp  of  fair 
intensity  for  the  application 
of  the  ultra-violet  and  vari- 
ous other  radiations  at  the 
discretion  of  the  operator. 
The  solar  arc  lamp  is  of  cheaper  and  simpler  construction  and 
provided  with  an  adjustable  arc  and  parabolic  reflector,  but 
employs  less  amperage  and  consequently  produces  less 
radiations.  It  must  be  observed  in  connection  with  this  lamp 
and  other  arc  lamps  provided  with  parabolic  reflectors,  that  as 
the  arc  is  drawn  from  the  reflecting  surface,  where  at  the  focal 
point  the  radiations  cross,  a  shimmer  which  the  uninitiated  are 
sometimes  led  to  believe  are  violet  radiations  appears  within  the 
center  of  the  light  ring.  As  a  matter  of  fact,  this  is  the  dark 
field  beyond  the  point  where  the  focused  rays  cross.  (See 


Fig.  7. 


SOURCES  OF  RADIANT  ENERGY  29 

Fig.  5.)  The  same  is  true  beyond  the  focal  point  of  the  incan- 
descent lamp,  provided  with  a  parabolic  reflector. 

The  elaborate  apparatus  of  Neils  Finsen  consisted  of  a  90- 
ampere  arc  placed  in  the  center,  the  radiations  being  projected 
through  four  tubes,  and  condensed  through  rock  crystal  lenses 
and  the  heat  rays  filtered  out  through  ice  or  cooled  water  placed 
in  the  tube.  Four  patients  placed  at  the  four  angles  were 
treated  at  one  time  with  the  involved  surfaces  pressed  against 
the  outer  lens  of  rock  crystal,  to  render  the  tissues  anemic,  a 
necessity  demonstrated  by  the  experiments  of  Finsen.  This 
apparatus  has  been  but  little  used  in  this  country,  though  sev- 
eral of  the  apparatus  have  been  installed,  because  the  ultra- 
violet rays  are  indicated  in  such  a  limited  number  of  cases,  par- 
ticularly the  types  of  lupus  which  are  very  rare  in  this  country ; 
and  because,  immediately  following  the  introduction  of  the 
methods  of  Finsen,  it  was  demonstrated  that  the  x-ray  was 
more  effective  in  the  treatment  of  these  conditions.  A  much 
less  expensive  and  equally  practical  apparatus  is  the  London 
Hospital  lamp  first  designed  by  Lortet  and  Genoud,  many  mod- 
ifications of  which  have  been  produced,  notably  the  one  shown 
in  the  accompanying  plate  manufactured  by  the  Victor 
Electric  Co.,  of  Chicago,  New  York  and  Boston.  This  type  of 
lamp  largely  supplanted  the  more  elaborate  lamp  of  Finsen. 
It  will  prove  of  value  in  a  limited  number  of  cases  which  may 
not  respond  properly  to  the  Roentgen  ray,  or  in  which  the 
x-ray  would  sacrifice  the  part,  as  the  lobe  of  an  ear  involved 
in  a  lupus  process. 

The  electric  incandescent  lamps. — A  large  number  of  thera- 
peutic lamps  of  the  incandescent  type  have  been  put  upon  the 
market,  all  of  which  possess  certain  degrees  of  merit.  A  lamp 
of  small  candle  power  is  valuable  for  applications  to  circum- 
scribed areas,  even  for  intense  local  treatment,  but  for  their 
effects  upon  general  metabolism  and  other  purposes  of  adminis- 
tration to  large  areas  are  not  practical,  as  they  consume  too 
much  of  the  time,  both  of  the  patient  and  physician.  Of  the 
high  candle  power  incandescent  lamps,  the  most  practical 
type  is  the  so  called  Leucodescent  lamp  manufactured  by 
Spear-Marshall  &  Co.,  of  Chicago,  (Fig.  8).  One  feature  of 
this  particular  lamp  is  the  character  of  the  reflection,  which 
instead  of  being  by  a  parabolic  reflector  with  one  focal  point,  is 
constructed  with  a  corrugated  reflector  and  conical  side  reflec- 


RADIANT  LIGHT  AND  HEAT 


tors  which  project  lines  in  parallel  and  crossing  lines  of  radia- 
tion having  two  parallel  fields  of  greatest  brilliancy  and  inten- 
sity, which  permit  the  operator  to  move  the  lamp  about  in  such 

a  manner  that  these  two 
fairly  large  fields  of  in- 
tense radiation  can  be 
tolerated,  as  they  cannot 
be  when  held  in  one 
position  directly  over 
the  regions  of  tender- 
ness or  inflammatory 
involvement.  At  the 
same  time  the  whole 
surface  receives  a  liberal 
radiation  of  light  and 
heat.  In  the  writer's 
experience  this  type  of 
lamp  meets  most  accept- 
ably the  demands  of  the 
localizing  incandescent 
lamp  for  general  thera- 
peutic administration. 
The  Minin  light,  devised  first  by  Professor  Minin  of  St. 
Petersburg,  consists  of  a  50  to  100  c.  p.  incandescent  lamp  with 
a  bulb  of  "natural-blue"  glass,  and  provided  with  a  reflector 
for  projecting  the  radiations.  While  various  claims  have  been 
made  as  to  the  anesthetic  effects  of  this  lamp,  in  the  writer's 
experience  the  only  advantage  he  has  discerned,  if  it  be  an 
advantage,  is  the  additional  heat  radiation  from  the  conversion 
of  the  luminous  and  other  frequencies  absorbed  by  the  glass 
into  heat  radiation.  In  other  words,  the  Minin  lamp  becomes 
a  radiator  of  heat,  but  in  this  respect  does  not  seem  to  have  any 
advantage  over  a  high  candle  power  lamp  which  may  be  raised 
and  lowered  over  the  surface  of  the  patient,  and  the  tempera- 
ture regulated  to  the  point  of  toleration  without  cutting  out  the 
generally  beneficial  light  radiations.  This  statement  is  made 
from  the  author's  observations,  in  view  of  the  fact  that  Pro- 
fessor Minin  and  others  have  reported  favorably  of  blue  light. 
The  manufacturers  of  the  Leucodescent  lamp,  Spear- 
Marshall  &  Co.  have  manufactured  screens  (Fig.  9)  con- 
structed of  narrow  strips  of  colored  glass  in  three  colors — 


Fig.  8. — Leucodescent  Lamp. 


SOURCES  OF  RADIANT  ENERGY  31 

blue,  orange  and  red.  When  fastened  to  the  lower  rim  of  the 
shield,  only  the  rays  of  the  particular  color  are  permitted  to 
pass  to  be  administered  together  with  the  heat  rays.  They 
also  make  a  small  hand  lamp  (Fig.  10),  the  "midget,"  pro- 


Fig.  9.  Fig.  10. 

Leucodescent  Screen  and  Small  Lamp. 

vided  with  50  candle  power  bulbs  of  white  and  the  other 
colors,  instead  of  screens  as  used  with  the  large  lamps. 

An  incandescent  lamp  manufactured  by  the  Victor  Electric 
Co.  is  constructed  with  sockets  for  four  lamps  and  provided 
with  individual  reflectors,  so  placed  as  to  throw  the  light  in 
practically  parallel  beams  of  light.  The  lamps  that  are  em- 


Fig,  ii. — Small  Victor  Lamp  and  Screen. 

ployed  are  of  various  candle  power  aggregating  from  200  to 
400  candle  power  for  the  four.  One  of  the  lamps  from  this 
group  is  provided  with  a  handle  and  may  be  removed  for  the 
purpose  of  use  as  a  hand  lamp,  similar  to  Fig  n,  for 
local  applications.  These  lamps  are  also  provided  with  small 


32  RADIANT  LIGHT  AND  HEAT 

glass  screens  of  orange,  blue,  and  red  which  may  be  adjusted 
over  the  front  of  the  small  shield,  whereby  local  administra- 
tions may  be  made  of  these  various  colors  if  desirable. 

There  are  numerous  other  incandescent  lamps  manufactured 
of  practically  the  same  design  as  the  small  "midget"  and  hand 
lamps  of  the  Victor  and  Spear-Marshall,  and  Frank  S.  Betz 
Companies,  which  are  convenient  for  the  treatment  of  local 
lesions  in  which  only  small  areas  are  to  be  treated.  When 
body  or  general  treatment  is  required,  however,  too  much 
time  is  necessary  for  the  administration  to  make  the  small 
lamps  practicable. 

Another  type  of  lamp,  the  Goerl  lamp,  in  which  the  radia- 
tions are  produced  by  sparking  between  balls  placed  in  circuit, 
usually  in  the  form  of  a  triangle,  so  that  sparks  will  pass 
steadily  between  the  balls  during  the  flow  of  the  current,  has 
been  modified  by  the  Victor  Electric  Company;  and  also  in 
the  Piffard  lamp,  manufactured  by  Waite  &  Bartlett.  A 
type  of  this  lamp  for  use  with  the  static  machine  is  also  manu- 
factured by  the  Van  Houten  &  Ten  Broeck  Company.  These 
lamps,  by  passing  a  considerable  current  through  the  circuit, 
produce  a  radiation  that  is  fairly  rich  in  ultra-violet  frequencies, 
and  may  be  used  in  lieu  of  the  more  expensive  lamps  for  mak- 
ing application  to  certain  superficial  lupus  patches,  etc.  As 
has  been  said  before,  these  lamps  furnishing  the  ultra-violet 
discharges  are  generally  less  efficient  in  their  action  than  the 
Roentgen  ray,  hence  their  therapeutic  value  is  not  of  so  great 
importance. 

The  mercury  vapor  lamp,  invented  by  Cooper  Hewitt,  and 
one  of  the  most  recent  sources  of  artificial  light,  is  peculiarly 
rich  in  the  ultra-violet  end  of  the  spectrum.  The  fact,  how- 
ever, that  the  light  produced  is  within  a  cylindrical  glass  tube, 
does  not  permit  the  radiation  of  the  higher  frequencies — the 
ultra-violet — and  is  deficient  in  heat  radiations. 

The  Uviol  lamp,  Fig.  12,  manufactured  in  Germany,  is  a 
mercury  vapor  lamp,  a  modification  of  the  Cooper  Hewitt  lamp. 
The  manufacturers  have  laid  claim  to  the  fact  that  the  quality 
of  the  glass  employed  permits  the  emanation  of  radiations  rich 
in  ultra-violet,  and  some  of  the  therapeutic  results  would  seem 
to  justify  the  claims.  However,  careful  test  made  by  the 
writer,  in  which  it  was  endeavored  to  pass  the  ultra-violet  rays 
through  the  glass  tube,  failed  to  produce  the  characteristic 


SOURCES  OF  RADIANT  ENERGY 


33 


green  fluorescence  of  willemite  or  the  characteristic  fluores- 
cence upon   a  platino-barium-cyanide   screen  in   a  darkened 
room. 
Light  bath  cabinets  are  properly  of  six  types;  the  first  two 


Fig.  12, — The  Uviol  Lamp. 

with  reference  to  the  position  of  the  patient  during  the  light 
bath  whether  (i)  sitting,  or  (2)  reclining  (upright  or  horizon- 
tal), and  two  with  reference  to  the  character  of  light  em- 
ployed, (3)  arc  or  mixed  baths,  and  (4)  the  distinctly  incan- 


34  RADIANT  LIGHT  AND  HEAT 

descent  bath  cabinet,  (5)  a  local  cluster  of  lamps  for  treating 
joints  or  localized  inflammatory  areas,  and  (6)  another  type 
in  which  a  high  power  incandescent  lamp  is  applied  over  a  long 
narrow  box  cabinet  with  a  glass  window.  These  may  be  still 
further  varied  by  the  employment  of  varying  colors  in  the 
baths;  for  which,  however,  there  seems  to  be  very  little  indi- 
cation ;  because,  on  general  principles,  the  employment  of  white 
light  is  in  most  cases  to  be  preferred  to  any  one  of  the  prismatic 
colors. 

The  types  of  construction  of  light  bath  cabinets  are 
based  upon  two  principles;  (i),  the  position  of  the  lights  and 
reflectors  in  such  a  manner  that  the  radiant  energy  will  be  di- 
rected towards  the  body  of  the  patient ;  and  (2),  that  the  capac- 
ity of  the  cabinet  shall  be  relative  to  the  number  of  lamps 
in  the  space,  or  the  degree  of  accumulated  heat  that  it  is  de- 
sirable to  administer  to  the  patient;  for  as  will  be  readily 
appreciated  from  the  first  lighting  of  the  bath  cabinet  when 
closed,  the  temperature  within  the  cabinet  increases.  The  ques- 
tion, therefore,  for  consideration  is,  shall  the  cabinet  be  large 
enough  to  permit  radiant  light  and  heat  to  produce  the  effects 
of  radiant  energy  upon  the  patient,  or  be  constructed  smaller 
in  proportion  to  the  number  of  lights  installed  in  order  that  the 
heat  accumulation  in  the  smaller  air  space  shall  raise  the  tem- 
perature of  the  bath,  that  the  mixed  effects  of  radiant  light 
and  heat  and  accumulated  convective  heat  shall  permit  the 
employment  of  a  high  temperature  within  the  cabinet.  As 
a  matter  of  fact,  the  general-purpose  bath  could  not  com- 
bine these  two  qualities  except  some  additional  means  be  pro- 
vided for  increasing  the  heat  within  the  bath  cabinet,  which 
may  be  readily  accomplished  by  making  provision  within  the 
larger  cabinet  for  placing  a  number  of  large  sized  blue  glass 
bulbs,  which  radiate  a  larger  percentage  of  heat  than  the  plain 
glass  bulb  of  equal  candle  power,  when  owing  to  the  fact  that 
the  luminous  rays  are  converted  into  heat  by  their  absorption 
in  the  glass  walls  of  the  colored  bulb,  convective  heat  is  evolved, 
which  effect  will  be  readily  appreciated  by  placing  a  finger 
against  a  colorless  glass  bulb  and  then  against  a  blue  one — both 
radiating. 

In  the  construction  of  a  light  bath  cabinet,  several  features  are 
to  be  considered,  (i)  The  cabinet  construction  should  be  of 
good  workmanship  if  not  to  be  lined  with  metal  sheeting,  which 


SOURCES  OF  RADIANT  ENERGY  35 

latter  plan  is  generally  objected  to  by  the  fire-underwriters, 
owing  to  the  possibility  of  short  circuits  through  the  metal 
lining  of  the  cabinet.  This,  however,  may  be  obviated  by  the 
employment  of  wood  pulp  sheeting  or  smooth  surfaced  as- 
bestos sheets,  placed  in  position  and  coated  with  white  enamel 
paint.  (2)  The  interior  shape  of  the  cabinet  should  be  such 
as  to  throw  the  light  generally  towards  the  center  of  the 
cabinet — the  space  to  be  occupied  by  the  patient.  The 
shape  of  the  cabinet  in  the  interior  should  therefore,  par- 
ticularly the  upright  type,  be  in  the  form  of  a  hexagon  or  an 
octagon.  The  character  of  the  reflecting  surfaces  should  be 
preferably  of  white  enamel  paint  or  white  porcelain,  reflecting 
mirrors  adding  very  little  of  the  real  utility  to  the  cabinet. 
Parabolic  reflectors  of  polished  metal  in  position  back  of  each 
of  the  incandescent  or  arc  lamps,  if  properly  focused  will 
aid  in  directing  the  radiations  towards  the  position  of  the  pa- 
tient in  the  cabinet.  (3)  The  size  of  the  cabinet  should  be 
such  that  the  individual  lamps  will  be  located  at  about  14  to 
1 8  inches  from  the  space  to  be  occupied  by  the  patient,  in  order 
that  the  patient  may  not  be  apt  to  come  against  the  sharp 
points  of  the  incandescent  lamps,  which  may,  however,  be 
placed  at  varying  angles,  preferably  at  an  angle  of  45°,  as 
the  greater  luminosity  is  projected  from  this  angle  with  the 
ordinary  incandescent  bulbs ;  whereas  with  specially  constructed 
bulbs,  such  as  are  used  with  the  smaller  hand-treatment  lamps, 
provided  with  parabolic  reflectors,  a  larger  amount  of  light  is 
projected  in  the  line  of  the  long  axis  of  the  lamp. 

In  hospitals  and  offices  where  invalids  of  all  types  are  to 
be  treated  a  reclining  bath  possesses  an  advantage  if  high 
temperatures  are  required,  particularly  in  patients  having  im- 
paired cardiac  force,  because  with  the  patient  reclining  there 
will  be  no  danger  of  syncope  during  the  administration ;  where- 
as in  the  upright  cabinet  the  dangers  of  this  sort  will  preclude 
the  use  of  the  light  bath  with  a  large  class  of  patients  for  which 
its  use  is  indicated.  For  the  family  light  bath  cabinet,  how- 
ever, in  most  instances,  the  upright  cabinet  would  fulfill  the 
purpose. 

The  incandescent  bath  possesses  the  same  advantage  for  thera- 
peutic administration  over  the  arc  light  that  the  large  incan- 
descent lamp  does  over  the  high  candle  power  arc  light,  as  pre- 
viously stated ;  because  while  it  is  rich  in  the  penetrating  lumi- 


36  RADIANT  LIGHT  AND  HEAT 

nous  rays  and  heat  radiations,  it  is  devoid  of  the  irritating 
effects  of  the  higher  frequencies  of  the  arc  light,  particularly 
the  ultra-violet,  and  also  from  emanations  from  the  arc  of 
nitrous  acid,  the  fumes  of  which  are  very  irritating  as  they 


Fig-  13- — Author's  Bath  Cabinet. 

escape  from  the  cabinet  or  when  the  cabinet  is  opened — 
producing  disagreeable  irritation  to  the  lungs  and  fauces  of 
the  patient  when  the  fumes  are  inhaled. 

If  the  arc  light  is  possessed  of  any  advantage  in  therapeutics 
over  the  incandescent  for  the  treatment  of  any  class  of  cases, 
it  resides  in  the  fact  that  the  reflex  effect  from  the  irritation 


SOURCES  OF  RADIANT  ENERGY 


37 


of  the  skin  by  the  ultra-violet  radiations,  or  other  action  of 
these  radiations  upon  the  skin,  possess  some  particular  advan- 
tage in  certain  skin  conditions.  For  the  administration  of 
radiant  light  and  heat  for  general  tonic  and  metabolic  effects, 


Fig.  14. — Betz  Reclining  Bath  Cabinet. 

the  radiations  having  the  higher  frequencies  filtered  out  are  in 
all  instances  to  be  preferred. 

Special  types  of  light  bath  cabinets  have  been  constructed  by 
various  manufacturers  to  meet  the  indications  for  the  treat- 
ment of  most  conditions. 

The  writer's  bath  cabinet  shown  in  Fig.  13,  was  constructed 
by  E.  B.  Meyrowitz  of  New  York  and  was  designed  to  treat 
patients  in  a  recumbent  position.  The  bath  is  provided  with 


38  RADIANT  LIGHT  AND  HEAT 

60  sixteen  candle  power  incandescent  lamps,  and  with  an  open 
work  chair  upon  which  the  patient  reclines.  A  door  is  placed 
at  the  one  end,  and  folding  doors  over  the  top,  with  an  opening 
for  the  protrusion  of  the  patient's  head  at  the  opposite  end. 

The  bath  cabinet  shown  in  Fig.  14  is  manufactured  by  Frank 
S.  Betz  of  Chicago  and  has  the  advantage  of  a  sliding  table 


Fig.  15. — Kny-Scheerer  Upright  Bath  Cabinet. 

which  permits  the  patient  to  be  pushed  into  the  bath  and 
withdrawn  at  the  end  of  the  treatment.  The  lights  in  this 
bath  are  arranged  on  all  sides  and  beneath,  the  patient  reclining 
upon  the  slatted  sliding  framework. 

The  upright  bath  cabinet  shown  in  Fig.  15,  is  manufactured 
by  the  Kny-Scheerer  Co.  of  New  York,  and  is  constructed 
for  giving  the  treatment  in  an  upright  position.  The  bath  is 
provided  with  mirrors  and  a  variety  of  colored  bulbs,  and  is 
exquisite  in  its  details  of  construction. 


Plate   II.— Treatment   with   Small   Bath   Cabinet  and  500   Candle   Power 

Lamp. 


SOURCES  OF  RADIANT  ENERGY  39 

Another  type  of  bath  cabinet  has  been  manufactured  by 
Spear-Marshall  Co.  for  the  writer  and  consists  of  a  portable 
collapsible  box,  the  sides  of  which  are  made  of  three  thick- 
nesses of  veneer,  and  finished  within  with  white  enamel.  One 
end  is  notched  out  for  the  head  of  the  patient.  Over  the  cab- 
inet is  fitted,  when  the  patient  is  in  position,  a  glass  window. 
The  object  of  this  cabinet  is  to  place  it  over  a  patient,  who  is 
reclining  for  treatment  upon  a  long  operating  table.  It  is  very 
convenient  for  use  when  space  is  an  element  to  be  considered, 
and  effective  in  administering  a  combined  radiant  light  and 
heat  and  convective  heat  bath  by  swinging  the  five  hundred 
candle  power  lamp  over  the  window  of  the  cabinet  (see 
Plate  II). 


CHAPTER  III 

PHYSIOLOGICAL   EFFECTS    OF    RADIANT    LIGHT 
AND  HEAT 

In  the  consideration  of  the  indications  for  radiant  energy 
in  therapeutics,  a  rational  basis  for  its  employment  calls  in 
each  class  of  conditions,  for  a  consideration  of  the  relation  of 
the  physical  properties  of  the  agents  to  their  physiological 
effects  upon  the  tissues. 

The  forms  of  radiant  energy  penetrate  the  tissues  to  vary- 
ing depths  producing  direct  physical  effects,  vibratory  in 
character,  and  secondary  chemical,  nutritional  and  reflex 
nervous  influences  upon  metabolism  and  the  nervous  mechan- 
ism. When  radiant  energy  impinges  upon  the  tissues  without 
passing  through,  heat  is  evolved  in  the  tissues  so  influenced,  in 
contrast  to  the  Roentgen  ray,  which  passes  through  the  tissues 
as  light  passes  through  the  window  pane,  without  the  evolu- 
tion of  heat. 

When  heat  is  evolved  at  the  periphery  from  the  impinging 
of  radiant  light  and  heat  radiations,  the  effect  is  not  only  local 
but  general.  A  glow  of  warmth  is  transmitted  throughout 
the  body  by  the  heated  blood  stream,  which  also,  when  long 
continued  or  extreme,  awakens  the  activity  of  the  excretory 
channels  through  the  sweat  glands,  and  maintains  the  body 
temperature  at  normal,  through  the  cooling  influence  of 
absorption  by  the  latent  heat  of  evaporation,  thereby  setting 
up  a  complex  influence  upon  metabolism,  far-reaching  in  its 
influences,  especially  so,  when  these  processes  so  essential  to 
healthy  existence  are  dormant. 

It  is  not  heat  alone  that  influences  metabolism,  but  the  pene- 
trating luminous  rays,  undoubtedly,  act  directly  upon  the  blood 
cells  in  the  circulating  streams,  and  this  influence  becomes 
marked  as  the  irradiated  tissues  become  hyperemic  under  pro- 
longed exposures,  and  in  a  short  period  of  time  the  blood  of 
the  whole  body  has  been  exposed  to  the  oxidizing  and  steriliz- 

40 


EFFECTS  OF  RADIANT  LIGHT  AND  HEAT      41 

ing  influences  of  light.  No  prolonged  local  administration  of 
radiant  light  and  heat  can  therefore  be  considered  local,  only; 
for  the  effect  is  coincidently  general  and  beneficial  in  all  con- 
ditions of  impaired  or  perverted  nutrition  and  poor  metabolism. 

The  local  influences  of  radiant  light  and  heat  from  the  usual 
sources  are  undoubtedly  due  chiefly  to  the  heat  effects,  very 
similar  effects  being  induced  by  convective  heat  as  shown  in 
another  chapter. 

The  hyperemia  induced  with  the  vasodilatation  is  undoubt- 
edly the  effect  which  exerts  the  greatest  local  influence 
upon  the  two  types  of  inflammation ;  in  the  simple  type  relax- 
jing_the.  tissues,  relieving  tissue  tension  and  pain;  while  in 
infectious  inflammation  vascularization  with  relaxation  and 
softening  permits  a  greater  supply  of  fresh  arterial  blood  to 
invade  the  infected  area  carrying  Nature's  scavengers,  the 
phagocytes,  under  favorable  influence  of  oxidation  where 
their  presence  is  demanded.  Where  infection  is  present  there 
is  the  additional  advantage  from  these  radiations  derived  from 
the  destructive  or,  at  least,  inhibitive  action  of  radiant  light 
and  heat  upon  the  germs  walled  in,  in  the  field  of  infection. 

Clinical  experience,  in  this  connection,  justifies  the  assump- 
tion that  radiant  and  convective  heat  and  radiant  light,  to 
which  the  higher,  less  penetrating  frequencies  are  not  essential, 
increase  most  favorably  local  phagocytosis  and  coincidently 
render  the  germs  inert;  a  combination  of  circumstances  al- 
ways effective  when  employed  with  energy  in  the  first  days  of 
superficial  infectious  processes,  and  advancing  recovery  at  any 
stage. 

It  has  to  all  intents  been  demonstrated  by  Neils  Finsen  that 
when  the  tissues  are  rendered  anemic  during  exposure  to 
ultra-violet  radiations,  their  action  is  destructive  superficially 
to  germ  life.  It  was  the  object  of  Finsen  and  his  cotem- 
poraries,  however,  to  carry  the  exposure  to  the  extent  of 
reaction ;  in  other  words,  to  the  extent  of  profound  hyperemia 
which,  in  the  light  of  effects  produced  in  the  treatment  of 
infection  under  conditions  of  hyperemia,  would  indicate  an  im- 
portant part  as  played  by  such  tissue  engorgement.  On 
the  other  hand,  the  best  results  were  obtained  when  the  tissues 
were  rendered  anemic  during  treatment,  manifestly  due  to 
the  antigermicidal  action  of  the  ultra-violet  radiations.  The 
final  result  is  undoubtedly  due  to  a  combination  of  the  two 


42  RADIANT  LIGHT  AND  HEAT 

effects,  germicidal  and  the  induction  of  the  increased  local 
phagocytosis  of  hyperemia. 

It  will  be  observed,  therefore,  in  the  treatment  of  all  local  or 
constitutional  conditions  by  radiant  light  and  heat  radiations, 
that  the  effects  are  due  to  the  same  physiological  effects,  which 
may  be  summarized  as  follows : 

/.  The  effects  upon  metabolism,  local  and  general,  are  due 
to  (i)  the  induction  of  increased  local  activity  of  elimination 
and  tissue  building;  (2)  diffusion  of  heat  throughout  the  body 
by  the  channels  of  circulation;  (3)  the  increased  general 
perspiration  induced  by  general  diffusion  of  heat,  when  ex- 
posures are  extensive  and  prolonged;  (4)  incr eased.- oxidation 
from  heat  induced,  and  the  local  action  of  radiant  light  upon 
the  blood  in  the  dilated  capillaries;  and  (5)  the  effects  upon 
the  remote  spinal  centers  due  to  peripheral  stimulation  of  the 
end  neurons  by  heat  and  light  radiations. 

II.  The  effects  upon  simple  inflammation,  unaccompanied  by 
infection,  is  (i)  to  induce  general  tissue  relaxations  with 
relief  of  pressure  and  pain;  (2)  by  increasing  local  metabolism 
and  elimination  to  relieve  the  tissues  of  the  irritating  products 
of  defective  metabolism  as  present  in  conditions  associated 
with  myalgias,  infectious  arthritis,  eczema,  and  similar  con- 
ditions; and  (3)  in  conditions  of  mild  traumatic  injury, 
treated  promptly  after  injury,  to  remove  early  stasis  and  cure 
the  condition,  but  is  ineffective  after  stasis  with  induration  is 
established. 

///.  In  acute  and  subacute  infectious  conditions  alone,  or  in 
connection  with  other  measures  which  inhibit  germ  processes 
or  increase  local  hyperemia  or  both,  (i)  it  increases  local 
hyperemia  in  the  region  of  infection  with  a  relative  increase 
of  leucocytes — the  phagocytes;  (2)  it  inhibits  the  activity  of 
the  germs  through  the  intensity  of  the  radiant  light  and  heat 
radiations,  and  (3)  it  stimulates  the  elimination  of  toxic 
materials,  local  and  diffused,  by  the  induction  of  perspiration 
and  increase  of  tissue  oxidation. 

By  these  means  local  phagocytosis  is  stimulated,  the  germs 
inhibited  and  devoured  and  the  toxic  material  eliminated. 

IV.  Derivative  effects  are  induced  when  extensive  exposures 
are  made,  rendering  the  surface  hyperemic  by  prolonged  ap- 
plications of  high  candle  power  incandescent  lamps  over  front, 
back,  and  sides,  or  by  the  arc  or  incandescent  light  bath  and 


EFFECTS  OF  RADIANT  LIGHT  AND  HEAT      43 

by  the  coincident  profuse  perspiration  induced;  (i)  lessening 
the  quantity  of  blood  in  congested  regions  and  the  larger  ar- 
teries and  veins;  (2)  lowering  arterial  tension;  (3)  relieving 
an  overworked  heart;  and  (4)  coincidently  promoting  ex- 
tensive elimination  of  the  locked  up  products  of  poor 
metabolism. 


CHAPTER  IV 

OF 


Success  or  failure  in  the  employment  of  radiant  energy,  de- 
pends upon  the  attention  to  proper  technic  as  to  method,  fre- 
quency, and  duration  of  treatment.  To  succeed  with  any 
physical  agent  in  therapeutics  depends  invariably  upon  the 
principles  of  treatment  employed,  comparisons  of  results  de- 
pending as  much  upon  the  men  employing  them  and  the 
methods  employed  as  upon  the  diagnosis  of  the  condition.  No 
physician  who  will  not  pay  strict  attention  to  the  requirements 
of  every  case,  with  intelligent  recognition  of  the  requirements 
of  each  case,  can  expect  to  succeed  with  the  application  of 
radiant  energy,  or  any  other  physical  or  other  agent.  Success 
here  as  in  most  things  will  depend  upon  the  judgment  as  to 
choice  of  modality,  and  the  knowledge  and  conscience  of  the 
physician  in  charge.  No  negligent  nor  heedless  person  can 
obtain  creditable  results  from  physical  measures.  The  self- 
indulgent  physician  may  succeed  in  some  cases  with  placebos 
and  suggestion,  but  in  the  cases  that  can  be  cured  by  physical 
agents  only,  an  anatomical  knowledge  and  the  mechanical 
sense  of  the  surgeon,  together  with  a  willingness  to  devote  the 
requisite  time,  technique,  and  energy  to  every  case,  are 
prerequisites. 

Local  administrations  of  light  should  be  employed  with  the 
primary  idea  of  inducing  local  hyperemia,  the  degree,  extent, 
and  frequency  of  application  to  depend  upon  the  requirements 
of  the  condition  under  treatment;  acute  inflammatory  affec- 
tions demanding  frequent  energetic  localized  applications,  par- 
ticularly in  infectious  cases — two  to  four  treatments  daily  be- 
ing essential,  as  in  acute  otitis  media. 

For  the  local  employment  with  a  view  to  relieving  local 
inflammation  the  effects  of  the  radiations  from  the  incandescent 
lamps  are  generally  to  be  preferred  to  the  electric  arc;  (i) 
because  the  intense  very  superficial  hyperemia  induced  by  the 
higher  frequencies  of  the  arc  light  which  are  filtered  out  by 

44 


Plate  III. — Method  of  Treatment  with  500  Candle   Power  Leucodescent 

Lamp. 


PRACTICAL  METHODS  OF  APPLICATION      45 

the  glass  of  the  incandescent  bulb,  induce  tanning,  interfering 
with  the  efficiency  of  subsequent  applications,  and,  (2)  be- 
cause the  risk  of  injury  to  the  superficies  from  the  higher  fre- 
quencies, does  not  permit  of  prolonged  application  of  the  pene- 
trating luminous  rays  and  infra-red  or  heat  radiations,  from 
which  the  greater  benefit  is  derived. 

The  hyperemia  of  the  ultra-violet  radiations  is  superficial 
and  intensely  irritating,  while  the  hyperemia  of  the  other  fre- 
quencies is  diffused  and  not  irritating,  with  an  added  greater 
and  unquestioned  beneficial  effect  upon  local  and  general 
metabolism. 

The  choice  of  lamps  as  to  candle  power  will  depend  upon 
the  extent  of  the  local  lesion  and  the  indication  for  general  as 
well  as  local  treatment. 

To  circumscribed  areas,  as  about  the  head  and  face,  or 
furuncles  or  carbuncles,  the  small  lamps  with  parabolic  re- 
flector (see  Figs,  n  and  12)  answer  every  purpose.  When, 
however,  larger  areas  are  to  be  treated,  or  when  general  as 
well  as  local  treatment  is  indicated,  lamps  of  high  candle 
power,  preferably  those  which  do  not  focus  all  of  the  rays,  are 
to  be  employed. 

For  general  or  constitutional  treatment,  the  lamps  of  high 
candle  power  which  project  practically  parallel  rays  or  rays 
crossing  in  various  directions  are  only  to  be  considered,  for 
otherwise  either  time  .or  thoroughness  are  compromised,  or 
both. 

The  method  of  local  administration  in  all  cases  as  stated 
elsewhere  is  best  effected  with  the  suspended  or  swinging 
lamp,  which  can  be  brought  close  to  the  bared  surface  of  the 
body  and  moved  rapidly  to  and  fro,  until  the  surface  is 
actively  hyperemic.  During  the  application  the  disengaged 
hand  of  the  operator  or  the  hands  of  the  patient  may  be  moved 
occasionally,  in  close  contact,  over  the  surface,  thereby  pro- 
ducing a  remarkable  cooling  effect  to  the  surface,  and  per- 
mitting more  intense  administrations. 

The  hand  of  the  operator  who  constantly  employs  high 
candle  power  lamps,  which  is  passed  over  the  body  of  the 
patient,  should  be  covered  with  a  glove  or  towel. 

The  duration  of  the  application: — Either  local  or  general 
treatment  should  be  continued  for  some  time  after  the  first 
flush  of  hyperemia  appears.  In  general  treatment  of  the 


46  RADIANT  LIGHT  AND  HEAT 

trunk  this  is  important,  because  a  necessary  degree  of  in- 
fluence is  not  induced  upon  the  circulating  blood  until  a  fair 
measure  of  hyperemia  is  present.  In  local  inflammation  of 
either  type,  it  is  important  to  carry  the  induction  of  local 
hyperemia  to  a  greater  degree  of  intensity  than  for  general  or 
constitutional  effects. 

Dermatitis  or  blistering  is  rarely  effected  by  the  radiant 
light  and  heat  radiations  from  the  incandescent  light,  nor  from 
the  incandescent  light  or  the  arc  radiations  passed  through 
glass  screens.  When  they  do  occur,  however,  as  they  may 
occur  in  very  susceptible  individuals  (cases  which  are  rare), 
the  effect  is  transitory  and  should  be  treated  as  an  ordinary 
burn;  whereas,  for  the  treatment  of  Roentgen  ray  dermatitis, 
no  agency  is  so  generally  efficient  as  applications  of  radiant 
light  and  heat — the  two  conditions  arising  from  opposite 
causes — one  from  excess  of  stimulation  and  the  other  from 
excess  of  inhibition. 

The  local  Fins  en  method  for  local  treatment  of  lupus  and 
epithelioma,  consists  of  the  application  of  the  ultra-violet 
radiation  passed  through  focusing  rock  crystal  lenses  or  rays 
focused  by  a  parabolic  reflector  and  then  passed  through  plane 
lenses  of  rock  crystal,  with  the  lens  or  an  outer  compression 
lens  pressing  against  the  surface  of  the  tissues  irradiated,  the 
pressure  being  employed  for  the  purpose  of  rendering  the 
tissues  anemic. 

Adrenalin  applied  to  ulcerated  surfaces  to  which  it  is  impos- 
sible to  exert  pressure,  as  in  the  nose,  has  proved  a  valuable 
accessory. 

The  method  of  Finsen  has  been  generally  superceded,  par- 
ticularly in  America,  by  the  more  satisfactory  employment  of 
the  x-ray  combined  with  static  and  high  frequency  applications, 
or  the  more  recent  employment  of  EMuvation  as  instituted  by 
Riviere  of  Paris  and  later  reported  by  Keating  Hart  under  the 
term  Fulguration. 

General  or  constitutional  treatment  for  effects  upon 
metabolism  may  be  administered  either  with  the  high  power 
incandescent  lamp,  the  patient  reclining  or  in  the  light  bath. 

General  treatment  with  the  high  candle  power  incandescent 
lamp  is  administered  to  the  trunk,  by  application  first  to 
one  part  of  the  surface  and  then  to  another,  swinging  the 
lamp  back  and  forth  lengthwise  over  the  body  until  the  sur- 


a 

3 


c 
a 
0 


PRACTICAL  METHODS  OF  APPLICATION       47 

face  is  more  or  less  hyperemic,  after  which  the  patient  is 
thoroughly  wiped  off,  dried,  and  dressed  for  vibration,  which 
should  follow,  being  administered  in  a  systematic  manner  on 
the  same  table,  to  be  followed  in  a  well-regulated  institution 
with  an  administration  of  the  wave  current  with  a  large  metal 
electrode  over  the  abdomen  or  some  other  place  indicated. 
Each  of  these  procedures  favorably  influences  general  and 
local  metabolism,  acting  as  congeners  in  impaired  constitu- 
tional states,  and  coincidently  in  trained  hands  meeting  local 
indications  as  well. 

The  light  bath  administered  to  the  patient,  seated  or  lying 
in  the  cabinet,  is  employed  for  its  effects  upon  general 
metabolism,  and  if  it  possesses  any  advantage  over  the  method 
described  by  use  of  the  high  c.  p.  lamps,  it  is  due  to  the  fact 
that  a  greater  degree  of  perspiration  is  induced  owing  to  the 
accumulation  of  a  high  temperature  within  the  cabinet,  and 
that  the  limbs  as  well  as  the  trunk  are  exposed  to  the  radia- 
tions. In  administering  light  baths  it  is  usually  customary  for 
the  head  to  protrude  from  the  top  or  one  side  of  the  cabinet. 
(See  Plate  VI,  page  76.) 

The  duration  and  after  treatment  will  vary  with  patients 
and  conditions.  When  profuse  elimination  is  sought,  thorough 
stimulation  of  the  sweat  glands  is  indicated.  The  exposure 
should  be  prolonged  to  30  or  40  minutes  after  which  the 
patient  may  remain  in  the  cabinet  for  a  longer  period  or 
be  removed  to  a  couch  and  rolled  in  blankets  and  allowed  to 
perspire  for  half  an  hour  longer,  after  which  he  may  be  given 
a  tepid  shower  bath  gradually  lowered  to  60°  R,  and  followed 
by  a  rub  and  mechanical  vibration  (general),  and  a  static 
wave  current  treatment  during  rest.  Instead  of  the  shower 
an  alcohol  rub,  vibration  and  static  may  be  administered. 

The  treatment  by  vibration  when  scientifically  administered 
is  for  many  reasons  superior  to  manual  massage.  The  addition 
of  the  static  treatment  with  a  metal  electrode  applied  over  an 
enlarged  or  congested  part  as  indicated  is  beneficial  in  all  cases 
and  should  replace  the  period  devoted  to  rest,  exhilarating  as  it 
does  the  patient  with  its  tonic  influence. 

With  feeble  patients  or  atonic  conditions,  the  time  devoted 
to  the  bath  should  not  be  prolonged  beyond  twenty  minutes, 
and  always  followed  when  possible  by  vibration  and  static 
or  auto-condensation  treatment.  When  the  static  is  not  at 


48  RADIANT  LIGHT  AND  HEAT 

hand,  and  the  auto-condensation  high  frequency  current  can 
be  administered,  it  is  indicated  except  in  failing  heart  con- 
ditions and  parenchymatous  nephritis,  in  which  high  tension 
which  is  compensatory  would  be  lowered  by  auto-condensa- 
tion. 

In  conditions  of  plethora  or  otherwise  abnormally  high 
tension,  associated  with  auto-intoxication,  auto-condensation 
should  constitute  a  routine  part  of  the  treatment. 

Light  baths  or  local  high  c.p.  incandescent  light  treatments 
may  be  administered  daily  or  on  alternate  days  according  to 
indications. 

During  administrations  the  pulse  and  temperature  should 
be  watched  and  treatment  should  be  discontinued  when  tem- 
perature reaches  ioo^°  F.,  or  the  pulse  becomes  weak,  rapid 
or  irregular.  Water  may  be  given  ad  libitum  throughout  and 
after  treatment,  except  in  conditions  of  edema,  where  it  is  de- 
sirable to  induce  absorption  of  the  serous  effusion.  It  is  cus- 
tomary and  agreeable  to  the  patient  to  cover  the  head  with  a 
moist  towel,  kept  cool  by  frequently  wringing  it  from  a  vessel 
of  cool  water. 


CHAPTER  V 
TREATMENT  OF   SIMPLE   INFLAMMATION 

A  classification  of  inflammatory  conditions  not  characterized 
by  the  presence  of  some  germ,  either  as  a  causative  or  conse- 
quent element,  is  often  difficult.  Conditions,  however,  arising 
from  trauma  or  other  accidents,  as  thrombosis  or  embolism,  or 
as  a  result  of  faulty  metabolism,  or  chemical  or  climatic 
causes,  may  be  properly  included  in  that  category.  So  also 
may  be  considered  some  post-operative  surgical  conditions. 

To  consider  the  therapeutics  of  various  conditions  from  the 
point  of  view  of  employment  of  one  modality,  as  of  light, 
would  be  misleading;  it  will  therefore  be  considered  proper  to 
incidentally  refer  to  other  measures  when  treating  of  the  ap- 
plications of  light  to  special  conditions. 

Conditions  arising  from  defective  or  perverted  metabolism 
as  the  myalgias,  inactive  secretions,  and  secondarily  of  arterio- 
sclerosis, and  perverted  conditions  associated  with  a  vicious 
circle  as  with  the  reflex  o_r  functional  neuroses  are  remarkably 
benefited  by  either  local  or  general  administrations  of  light. 

With  simple  inflammation  in  contradistinction  to  infection, 
the  curative  effects  of  radiant  energy  will  depend  upon  the  ex- 
tent and  site  of  the  lesion,  as  well  as  upon  its  chronicity.  In- 
juries arising  from  superficial  trauma,  as  wounds  or  sprains, 
of  small  joints,  when  treated  early,  may  be  largely  relieved  by 
the  energetic  application  of  radiant  light  and  heat ;  whereas,  in 
the  treatment  under  similar  conditions  of  large  joints  or  deep- 
seated  injuries,  it  will  be  quite  inadequate  in  any  event;  as 
also  in  the  treatment  of  inflammation  in  which  stasis  is  fairly 
extensive  and  well  established.  It  is  absolutely  useless  to  ex- 
pect to  relieve  established  stasis  by  treatment  with  this  form 
of  energy.  For  the  relief  of  regions  of  local  stasis,  those  who 
are  familiar  with  their  action  and  use,  turn,  naturally,  to  the 
static  currents,  which  by  throwing  the  involved  tissues  into 
activity,  by  the  induction  in  them  of  rapid  contraction  and 
vibration,  alternating  with  intervals  of  rest,  which  force  out 
the  infiltration,  induce  active  metabolism  and  restore  the  lym- 

49 


50  RADIANT  LIGHT  AND  HEAT 

phatic  and  blood  circulation  by  pressing  open  the  venous  and 
lymphatic  channels. 

Pain  is  relieved  by  the  application  of  radiant  light  and  heat 
energy  in  regions  of  local  inflammation  on  account  of  the  in- 
duced relaxation  of  the  tissues,  the  increased  elasticity  induced, 
relieving  the  pressure  upon  the  nerve  filaments,  which  is  un- 
doubtedly due  largely  to  the  effect  of  the  radiant  heat,  as  the 
same  effects  are  derived  to  a  less  degree  by  applications  of 
convective  heat.  This  relief  of  pain  should  not  delude  any  one 
into  expecting  to  effect  the  cure  of  an  inflammatory  process  in 
which  stasis  is  once  established  for  the  effect  is  transitory,  not 
curative.  So  in  the  treatment  of  sciatica,  brachial  neuritis,  or 
severe  sprains,  excepting  in  the  earlier  stage  of  the  affection, 
it  is  useless  to  expect  to  afford  more  than  temporary  relief  from 
the  administrations  of  radiant  energy,  whereas  the  employment 
of  the  static  electrical  currents  insures  prompt  relief  and  the 
ultimate  cure  of  these  conditions,  when  accessible;  i.  e.,  when 
not  within  the  chest  or  pelvis.  Radiant  light  and  heat,  how- 
ever, in  connection  with  the  static  currents,  are  useful  in  the 
treatment  of  the  forms  of  neuritis  and  joint  inflammations,  but 
must  be  employed  in  all  cases,  if  at  all,  before  the  static  cur- 
rent is  applied,  for  the  purpose  of  improving  impaired  local 
metabolism  and  nutrition  in  the  tissues  involved  on  account  of 
the  lowered  function  of  the  local  nervous  mechanism.  Ap- 
plied in  these  conditions  it  affords  temporary  relief  from  pain, 
but  is  not  instrumental  in  removing  the  bete  noire  of  simple  in- 
flammation— inflammatory  stasis;  its  only  function  being  to 
prevent  inflammation  at  the  outset ;  but  when  once  established, 
radiant  light  and  heat  are  absolutely  impotent.  When  applied 
after  static  treatment,  radiant  light  and  heat  relax  again  the 
tissues  rendered  tonic  at  the  site  of  the  lesion  where  accumu- 
lated infiltration,  which  is  causing  pain  by  pressure,  has  been 
forced  out  by  the  contraction  induced  in  the  tissues  by  the 
current. 

Post-operative  use  of  radiant  light  and  heat  employed  im- 
mediately over  the  site  of  the  operation  is  valuable  from  three 
points  of  view:  (i)  relief  of  pain;  (2)  the  prevention  of  scar 
tissue  in  the  line  of  sutures;  and  (3)  the  induction  of  active 
hyperemia  which  promotes  nutrition,  and,  by  the  local 
increased  presence  of  phagocytes  in  the  region  involved,  les- 
sens the  possibility  of  local  infection. 


TREATMENT  OF  SIMPLE  INFLAMMATION      51 

The  same  principle  applies  to  the  treatment  of  sites  of  local 
operation  as  well  as  of  recent  wounds  and  injuries,  and  for  the 
same  reasons.  In  myalgias,  muscular  sprains,  and  local  areas 
of  pelvic  tenderness  and  pain,  the  beneficial  effects  of  light  and 
heat  radiations  will  depend  mostly  upon  relief  of  disturbances 
of  metabolism  or  its  effects  upon  the  presence  of  local  infection. 

The  method  of  treatment  of  simple  inflammation,  as  well  as 
of  the  infectious  type  of  inflammation,  consists  in  the  localized 
application  of  light  either  from  a  small  hand  lamp  of  50  to  100 
candle  power  when  the  affection  is  slight,  or  the  employment  of 
a  lamp  of  higher  candle  power  for  constitutional  treatment  or 
over  large  areas.  In  the  treatment  with  light  under  these 
conditions,  the  application  should  be  made  at  a  distance  that 
will  give  as  high  a  temperature  as  the  patient  can  withstand. 
The  disengaged  hand  of  the  operator  or  the  hand  of  the  patient, 
when  frequently  passed  over  in  contact  with  the  surface  dur- 
ing the  administration  of  radiant  light  and  heat,  affords  tempo- 
rary relief,  making  it  possible  to  keep  up  the  treatment  more 
energetically  than  otherwise.  In  applying  radiant  light  and 
heat,  the  application  should  not  be  made  with  the  lamp  in  a 
fixed  position,  but  by_  constantly  moving  it  about  or  swinging  it 
to  and  fro  over  the  involved  area.  The  light  should  be  em- 
ployed in  this  manner  for  two  reasons,  (i)  As  great  a  degree 
of  temperature  cannot  be  applied  persistently  as  interruptedly, 
and  (2)  because  administered  interruptedly,  waves  of  contrac- 
tion are  induced  in  the  tissues  in  response  to  the  stimulating 
effect  of  the  intense  heat,  and  in  the  interval  before  the  sub- 
sequent application  there  is  a  relative  relaxation.  The  stimu- 
lation to  contraction  and  intervening  release,  operates  to  a  de- 
gree in  the  same  manner  with  the  alternate  contraction  and  re- 
laxation, occurring  with  the  application  of  the  static  wave  cur- 
rent, and  so  effects  to  a  less  degree  the  relief  of  local  inflam- 
mation and  stasis  by  tissue  drainage. 

The  myalgias  arise  undoubtedly  from  the  effects  of  defec- 
tive metabolism  under  conditions  of  exposure  to  cold,  draughts 
or  wetting  of  the  clothing;  and  are  liable  to  arise  after 
fatigue  in  those  of  inactive  pursuits,  particularly  in  the  debil- 
itated. Under  the  drug  regime  they  are  prone  to  become 
chronic,  the  soreness  and  stiffness  often  persisting  with  ex- 
acerbations for  years.  The  affection  is  confined  to  no  set  or 
group  of  muscles,  but  is  probably  most  common  in  the  regions 


52  RADIANT  LIGHT  AND  HEAT 

of  moderate,  not  of  greatest  activity,  as  the  back  and  neck — 
lumbago  and  torticollis. 

Muscular  soreness  in  the  limbs  of  the  active  soon  disappears, 
due  to  the  effect  of  such  activity  upon  metabolism,  and  for 
the  same  reason  they  are  less  apt  to  be  affected,  whereas 
the  dense  less  active  muscles  of  the  back  are  most  apt  to  be 
involved — the  regions  of  lesser  activity.  Lumbago  and  torti- 
collis are  the  most  common  of  the  myalgias. 

Lumbago,  the  type  under  consideration,  should  not  be  con- 
fused with  a  type  of  lumbar  arthritis  arising  from  sprain  or 
traumatic  injury  of  the  spine. 

While  in  acute  myalgias  radiant  light  and  heat  energetically 
applied  are  remarkably  efficacious,  in  the  chronic  or  more  severe 
forms  they  do  not  compare  with  twenty-minute  applications  of 
the  static  wave  current  with  an  energy  just  short  of  inducing 
muscular  contraction,  followed  by  a  few  well-directed  static 
sparks.  Everyone  who  has  become  familiar  with  the  use  of 
static  electricity  has  had  success  from  the  employment  of  the 
static  methods.  When  used  in  association  with  static  applica- 
tions, as  in  other  inflammatory  conditions,  the  light  should 
always  precede  the  static  treatment  for  reasons  elsewhere 
given. 

Various  writers  have  reported  results  from  the  employment 
of  light  in  lumbago. 

Delvers  reports  a  case  of  lumbago  of  two  weeks'  standing 
cured  by  the  daily  treatment  of  fifteen  minutes  each  with  a 
high  c.p.  incandescent  lamp. 

Russels  of  Chicago  reports  a  case  in  a  patient  sixty  years 
of  age,  of  ten  years'  standing,  as  cured  by  sixteen  fifteen- 
minute  treatments.  The  treatments  were  given  daily  for  six 
days  and  afterwards  twice  weekly.  The  radiant  light  and 
heat  was  administered  with  a  high  c.  p.  incandescent  lamp,  held 
as  close  as  it  could  be  borne.  Four  months  later  there  had 
been  no  relapse.  This  patient  also  observed  that  without 
other  treatment  his  bowels,  which  had  been  constipated,  became 
regular  after  the  sixth  treatment. 


CHAPTER  VI 

RADIANT  ENERGY  IN  THE  TREATMENT  OF  IN- 
FECTIOUS PROCESSES 

The  greater  field  of  usefulness  of  radiant  light  and  heat 
energy  is  found  in  its  remarkable  potency  when  associated  with 
its  congeners — the  x-ray,  high  frequency  currents,  and  con- 
vective  heat  in  the  treatment  of  infectious  inflammation. 

The  attention  being  paid  at  this  time  to  the  subject  of 
hyperemia,  as  influencing  inflammatory  conditions,  has  until 
recently  ignored  the  important  fact  that  local  phagocytosis  is 
the  important  effect,  to  which  the  writer  called  attention  edi- 
torially in  THE  JOURNAL  OF  ADVANCED  THERAPEUTICS  for 
March,  1907. 

Probably  no  investigation  of  recent  days  has  been  so  full  of 
significance  and  so  fruitful  of  a  revolutionary  procedure  as  the 
treatment  of  local  and  general  infections.  The  work  of 
Wright  in  the  discussion  of  opsonic  indices  of  resistance,  has 
opened  up  a  new  point  of  view  in  connection  with  the  all  but  es- 
tablished theories  of  Metchnikoff  of  phagocytosis. 

The  fact  that  a  region  is  rendered  intensely  hyperemic  by 
the  application  of  an  agency  which  brings  into  the  field  of  in- 
fection an  increased  influx  of  fresh  arterial  blood,  rich  in 
phagocytes,  favoring  a  positive  chemotaxis,  as  previously  sug- 
gested by  the  writer,  establishes  rationally  the  indication  of 
such  measures  as  accomplish  that  effect  for  the  treatment  of  all 
types  of  local  infection.  If  an  increased  influx  of  blood  were 
associated  with  a  coincident  relief  of  the  induration  which 
walled  in  an  advanced  infection,  the  employment  of  measures 
which  induce  local  hyperemia  would  be  involved  in  an  ele- 
ment of  danger,  lest  the  infection  might  thereby  be  dissemi- 
nated. In  the  relaxation  of  tissue  which  does  occur,  however, 
there  is  sufficient  influx  of  fresh  blood  to  the  seat  of  the  in- 
fection, carrying  with  it  fresh  phagocytes,  to  destroy  the  germs 
in  an  infectious  process  without  the  danger  of  extending  the 
infection. 

The  means  at  present  in  vogue  by  the  votaries  of  the  meth- 

53 


54  RADIANT  LIGHT  AND  HEAT 

ods  of  Bier,  are  fraught  with  elements  of  defect  not  found  in 
the  relief  of  local  infection  by  the  x-ray,  light  and  the  high 
frequency  currents.  Their  errors  reside  in  the  facts,  that  (i) 
powerful  suction  produces  a  degree  of  mechanical  injury  to  the 
local  area,  and  (2)  because  the  method  by  bandaging,  cutting 
off  the  return  venous  circulation  and  preventing  a  normal  in- 
flux of  arterial  blood,  creating  a  deficiency  of  oxygen  in  the 
tissues,  does  not  favor  positive  chemotaxis;  because  of  the 
venous  stasis  induced.  Whereas  in  the  employment  of  radi- 
ant light  and  heat,  two  effects  are  produced  unfavorable  to 
the  germs  in  the  localized  area,  the  tendency  of  which  is  op- 
sonic  :  ( i )  the  actinic  action  of  light  is  adverse  to  the  activity 
and  energies  of  many  types  of  bacteria,  and  (2)  that  the  germs 
which  exist  upon  the  human  body  develop  most  favorably  at 
the  body  temperature  of  98.4,  and  are  inhibited  by  the  energetic 
application  of  radiant  light  and  heat,  while  the  blood  stream, 
which  is  passing  in  and  out  of  the  area,  is  cooled  at  the  peri- 
phery, returning  constantly  in  a  fresh  stream  to  the  site  of 
involvement,  thereby  giving  advantage  to  the  phagocytes  with 
adverse  conditions  exerted  upon  the  elements  of  infection — in 
effect  opsonic.  It  is  furthermore  probable  that  under  the  ap- 
plications of  radiant  light  and  heat  the  phagocytes  are  more 
active  in  their  war  upon  the  bacteria. 

It  is  already  a  well-demonstrated  fact  now  that  these 
theories  as  to  the  action  of  radiant  light  and  heat  upon  the 
germs  and  phagocytes  are  correct;  or  that  if  not  for  the 
reasons  given,  they  are  for  some  other  reasons;  for  clinically 
the  effect  upon  local  infection  of  these  applications  is  that 
such  processes  do  yield  to  the  combined  application  of  radiant 
light  and  heat,  convective  heat  and  the  high  frequency  cur- 
rents, all  of  which  induce  intense  local  hyperemia,  and  that  the 
promptness  and  energy  with  which  the  effects  are  obtained  are 
accentuated  by  the  previous  applications  of  the  Roentgen  ray, 
which  probably  is  due  to  the  fact  that  the  ray  sterilizes  or  in- 
hibits the  activity  of  the  germs  localized  in  the  area  of  infec- 
tion, while  the  elements  of  the  blood  which  are  shielded,  ex- 
cept as  they  pass  rapidly  across  the  field  of  irradiation,  are 
not  adversely  affected  by  the  Roentgen  ray. 

It  is  the  writer's  practice  in  the  treatment  of  infectious  con- 
ditions, to  make  a  prolonged — twenty  to  thirty  minute — ex- 
posure to  the  Roentgen  ray,  making  use  of  the  energy  usually 


TREATMENT  OF  INFECTIOUS  PROCESSES       55 

employed  in  the  treatment  of  skin  diseases  for  the  purpose  of 
inhibiting  the  activity  of  the  germs  and  then  permitting  an  in- 
terval of  twelve  to  eighteen  hours  before  the  administration  of 
the  radiant  light  and  heat,  or  high  frequency  current  or  both. 
The  germs  thus  brought  into  a  state  of  complete  inhibition,  in- 
creased by  the  delay,  are  so  affected  that  the  phagocytes 
brought  fresh  into  the  area,  and  in  larger  numbers,  with  the 
hyperemia  induced  by  the  radiant  energy,  devour  them  with 
a  greater  certainty.  By  this  method  it  is  possible  to  abort  any 
accessible  pus  process  prior  to  fluctuation. 

Specialised  employment  of  radiant  energy  offers  a  means 
in  therapeutics  especially  valuable  in  the  treatment  of  infectious 
processes, — tubercular,  gonorrheal,  streptococcic,  or  staphylo- 
coccic;  in  fact,  in  all  germ  processes  in  which  a  local  activity 
of  the  phagocytes  is  capable  of  destroying  the  infection.  The 
possibilities  of  success  or  number  or  frequency  of  exposures 
will  vary  with  the  relative  opsonic  index  of  the  individual  un- 
der treatment.  An  important  principle  in  the  treatment  by 
hyperemia  resides  in  the  internal  resistance  of  the  subject  or 
patient — the  capacity  of  the  leucocyte  to  seize  upon  more  or  less 
of  the  germs  in  the  field  of  infection.  It  is  an  important  ques- 
tion whether  a  greater  number  of  leucocytes  caused  to  enter  the 
field  of  infection,  while  each  consuming  a  smaller  number  of 
germs,  may  not  accomplish  the  same  ultimate  result  as  a  smaller 
number  of  leucocytes  under  a  higher  index,  or  whether  agents 
which  inhibit  the  activity  of  the  germs,  as  the  x-ray,  radiant 
light  and  heat,  and  the  high  frequency  currents,  by  increasing 
hyperemia,  do  not  coincidently  inhibit  or  lower  the  activity  or 
resistance  of  the  germs  whereby  their  destruction  is  facilitated 
under  any  condition. 

Clinically  the  writer  has  demonstrated  the  truth  of  each  of 
these  propositions,  to  the  extent  that  it  can  be  confidently  as- 
serted:— That  in  all  infectious  conditions  susceptible  to  the 
leucocytic  influence,  at  the  proper  stage,  and  in  regions  acces- 
sible to  measures  which  induce  intense  local  hyperemia,  under 
conditions  of  positive  chemotaxis,  it  is  possible  under  favor- 
able conditions  to  abort  such  processes  by  destruction  of  the 
cause. 

No  agent  of  equal  intensity  is  more  powerful  in  contributing 
the  three  most  important  elements  favorable  to  the  induction 
and  natural  effects  of  local  phagocytosis  than  radiant  light  and 


$6  RADIANT  LIGHT  AND  HEAT 

heat ;  and  for  such  favorable  action  the  ultra  violet  frequencies 
are  not  important;  viz.,  (i)  the  inhibition  of  germ  life,  (2) 
the  induction  of  local  hyperemia,  and  (3)  increased  presence 
of  oxygen  favoring  a  positive  chemotaxis.  The  high  fre- 
quency current  produces  a  deeper,  more  intense,  and  more 
persistent  hyperemia,  and  an  inhibitory  influence  of  different 
character  and  capacity,  but  probably  farther  reaching  under 
favorable  conditions,  as  when  the  drArsonval  current  is  passed 
through  the  tissues  between  two  electrodes,  but  is  deficient  in 
the  important  heat  radiations. 

The  action  and  uses  of  the  three  forms  of  radiant  energy 
included,  may  be  summarized  as  follows : 

I.  The  action  of  the  Roentgen  ray  upon  germ  life  is  inhibi- 
tory; probably  not  directly  destructive,  but  by  rendering  the 
microbes  inert  and  checking  their  propagation,  they  become  an 
easy  prey  to  the  phagocytes.  To  derive  the  maximum  effect 
from  the  x-ray  in  conjunction  with  other  agents  an  interval 
of  12  to  24  hours  should  intervene,  following  a  massive  dose 
of  10  to  25  minutes  according  to  the  volume  of  radiations. 
With  the  ordinary  static  machine  of  twelve  revolving  plates 
making  400  to  500  revolutions  per  minute,  the  exposure  for  a 
massive  dose  should  be  of  25  minutes  duration.  Employed  in 
this  manner  the  x-ray  adds  to  the  efficiency  of  the  means  which 
induce  local  hyperemia,  in  the  treatment  of  infectious  con- 
ditions. 

//.  The  action  of  radiant  light  and  heat  as  previously  stated 
is  (i)  to  induce  active  hyperemia;  (2)  to  increase  local  oxida- 
tion with  the  induction  of  positive  chemotaxis,  and  (3)  to 
inhibit  or  exhaust  walled-in  germ  processes,  while  the  constant 
influx  of  cooled  blood  into  the  field  through  the  relaxed  walls 
brings  leucocytes  fresh  for  the  fray. 

///.  High  frequency  currents  (i)  produce  profound  local 
hyperemia;  and  (2)  undoubted  actinic  and  other  antiseptic 
effects  adverse  to  germ  life. 

In  cystitis,  and  the  deeper-seated  pus  processes,  the  em- 
ploymenTof  the  x-ray  should  be  persisted  in  with  10  minute  ex- 
posures on  alternate  days  until  the  pus  has  entirely  disappeared 
from  the  urine.  These  observations  are  based  upon  a  series  of 
clinical  results  by  the  writer  in  the  treatment  of  carbuncles, 
felons,  furuncles,  cystitis,  and  other  septic  infections,  without 
an  unsatisfactory  result  during  a  period  of  five  years. 


TREATMENT  OF  INFECTIOUS  PROCESSES       57 

It  can  be  truly  said  that  in  the  applications  of  radiant  light 
and  heat,  the  x-ray,  and  high  frequency  currents  we  possess 
the  greatest  means  for  coping  with  a  large  class  of  infectious 
conditions,  particularly  the  streptococcic  and  staphylococcic 
infections.  We  have  reason  to  believe  that  the  same  rule  ap- 
plies equally  to  tuberculosis  and  gonorrhea,  and  to  a  greater 
or  less  degree  in  all  other  types  of  inflammation  arising  from 
infectious  causes.  It  is  a  subject  fraught  with  the  greatest 
possibilities  and  deserving  immediate  serious  investigation,  and 
general  adoption. 

The  three  agents  may  be  considered  congeners  in  infections, 
and  while  each  when  used  alone  may  succeed  in  selected  cases, 
their  combined  use  in  the  treatment  of  most  infected  conditions, 
when  skillfully  managed,  is  most  effective. 

It  is  impossible  to  consider  the  treatment  of  any  class  of 
conditions  intelligently  with  the  use  of  one  modality,  for  though 
in  selected  cases  it  may  prove  efficient,  in  others  another 
modality  or  combination  may  be  required.  So  in  a  treatise  on 
radiant  energy,  or  any  other  subject,  when  the  therapeutics  is 
considered,  the  indication  and  use  of  congeners  and  antagonists 
of  the  agent  under  consideration  should  be  included. 

Otitis  media,  either  the  acute  or  chronic  form,  is  a  condition 
which  under  the  ancien-  regime  and  even  in  the  hands  of  many 
modern  otologists  has  too  often  been  left  with  the  possible 
paracentesis   to  the   further   working  of  the   vis  medicatrix 
natures. 

No  greater  mistake  can  be  made  than  to  fall  into  this  error, 
when  in  the  light  of  known  possibilities  the  condition  can  always 
be  aborted  in  the  early  stage  and  cut  short  in  any  stage. 

The  indication  is  to  inhibit  the  pyogenic  bacteria  and  destroy 
them  by  the  induction  of  an  intense  local  hyperemia  in  the  field 
of  infection. 

Treatment. — Radiant  light  and  heat  and  to  a  less  degree  con- 
vective  heat  are  eminently  successful  in  meeting  both  indica- 
tions. Applications  of  radiant  energy  from  either  the  smaller 
lamps  of  50  c.  p.  are  made  as  near  the  surface  as  can  be  borne, 
or  with  lamps  of  higher  c.  p.  for  15  to  20  minutes  or  longer  if 
pain  is  not  relieved,  every  3  to  12  hours  according  to  severity, 
the  recurrence  of  pain  being  the  indication  for  repetition  of 
treatment.  When  convective  heat  is  employed  the  heat  should 
be  maintained  at  as  high  a  temperature  as  can  be  borne,  for 


58  RADIANT  LIGHT  AND  HEAT 

from  three  to  five  hours  consecutively,  and  repeated  for  a  like 
period  if  there  is  any  recurrence  of  the  pain.  Radiant  light 
and  heat  application  is  the  method  to  elect,  convective  heat 
being  only  permissible  in  lieu  of  the  preferred  method  not  being 
at  hand. 

In  chronic  otitis  media,  frequent  short  exposures  of  the 
x-ray  may  be  made  on  every  second  day  for  ten  minutes,  alter- 
nated with  radiant  light  and  heat  for  half  an  hour  to  an  hour, 
or  a  more  approved  plan  is  to  make  one  exposure  of  the  x-ray 
for  20  minutes,  followed  after  18  to  24  hours  by  prolonged  in- 
tense daily  treatments  with  radiant  light  and  heat  until  the  dis- 
charge of  pus  ceases.  Except  there  are  necrotic  ossicles  this  plan 
of  treatment  will  effect  a  cure  in  most  chronic  cases  within  three 
weeks.  The  additional  application  of  high  frequency  currents 
over  the  mastoid  and  in  front  of  the  tragus  will  hasten  the 
recovery  in  severe  cases. 

Mastoiditis. — The  same  plan  of  treatment,  including  the 
application  of  the  x-ray  as  described  above,  will  in  the  early 
stage  abort  this  distressing  condition,  as  has  been  demonstrated 
in  the  writer's  experience  and  that  of  others,  as  the  following 
cases  attest. 

Dr.  T.,  dentist,  came  under  observation  after  having  had  an 
otitis  media  for  three  months  with  no  sign  of  abatement.  She 
came  under  treatment  with  the  consent  of  the  aurist  under 
whose  care  she  had  been  on  account  of  her  desire  to  go  abroad 
in  five  weeks,  and  having  no  assurance  that  other  treatment 
would  relieve  the  condition.  On  the  day  that  she  applied  for 
treatment  she  had  forcibly  injected  water  into  the  middle  ear 
and  came  the  following  day  with  a  developed  mastoiditis,  with 
pain  and  marked  tenderness  over  the  mastoid,  and  the  outer  ear 
standing  out  in  the  characteristic  manner.  Having  employed 
the  x-ray  for  20  minutes  on  the  first  day,  on  the  next  day,  when 
she  came  with  the  mastoid  involvement,  light  from  a  high  candle 
power  incandescent  lamp  was  administered  for  about  30 
minutes,  until  an  intense  general  hyperemia  was  induced  over 
the  region,  followed  by  a  15  minute  application  of  the  high  fre- 
quency current  with  a  glass  vacuum  tube.  This  application 
was  made  twice  daily  for  three  days  when  the  mastoid  com- 
plication had  entirely  subsided,  improving  from  the  first  applica- 
tion. Treatment  was  continued  daily  for  three  weeks  in  the 
same  manner  when  the  discharge  of  pus  had  ceased  and  she  was 


TREATMENT  OF  INFECTIOUS  PROCESSES       59 

pronounced  cured  by  her  previous  attendant,  who  by  letter  com- 
mended the  method  and  result,  acknowledging  that  both  a  mas- 
toiditis  and  the  otitis  media  had  been  cured. 

The  following  cases  were  reported  by  Dr.  Herbert  F.  Pitcher 
of  Haverhill,  Mass.* 

"  A  case  of  mastoiditis  was  cured  in  five  treatments.  This 
case,  a  woman,  thirty-six  years  of  age,  had  been  treated  a  week 
by  the  usual  remedies  before  I  saw  her.  She  complained  of 
very  severe  pain  in  and  around  the  ear  and  mastoid,  with 
tenderness  on  pressure  and  pain  on  percussion  over  the  mastoid 
bone.  The  membrana  tympani  was  red  and  inflamed,  and 
temperature  100.2°  F.,  without  chill. 

"  Application  of  strong  light  was  made  over  the  mastoid,  in 
and  around  ear,  side  of  the  face,  head,  and  neck  of  affected  side 
for  fifteen  minutes.  She  returned  next  day  with  a  report  of  a 
good  night's  rest,  but  some  pain  yet.  Another  application,  the 
same  as  before,  was  made.  The  patient  said  there  was  abso- 
lutely no  pain  when  she  left  the  office,  and  there  was  no  pain 
whatever  after  that.  She  received  three  more  applications  with 
complete  subsidence  of  the  inflammation,  and  there  has  been  no 
trouble  since. 

"  A  man,  sixty-three  years  of  age,  weighing  240  pounds,  had 
the  grippe,  followed  by  severe  pain  in  right  side  of  his  head  and 
ear  for  three  weeks.  The  last  week  the  pain  was  so  severe  he 
could  neither  sleep  nor  eat.  When  I  saw  him  he  was  a  wreck. 
There  was  a  profuse  purulent  discharge  from  the  ear,  the 
membrana  tympani  was  ruptured,  and  the  typical  conditions 
with  the  symptoms  of  acute  purulent  otitis  media.  After 
thorough  cleansing  of  the  canal  I  applied  the  light  for  fifteen 
minutes  to  the  painful  side  of  the  head  and  neck,  and  into  the 
orifice  of  the  external  meatus. 

"  The  patient  returned  next  day  saying  that  he  had  had  the 
first  good  night's  rest  for  three  weeks.  He  received  six  treat- 
ments with  the  result  that  pain  and  inflammation  have  entirely 
subsided,  discharge  ceased,  and  the  patient  was  feeling  as  well 
as  usual.  There  has  been  no  return  of  ear  trouble. 

"  I  could  enumerate  many  cases  of  like  conditions  and  re- 
sults. It  is  a  source  of  great  satisfaction  to  me  to  be  able  to 

*  Phototherapy  in  General  Practice,  ADVANCED  THERAPEUTICS,  June, 
1906. 


60  RADIANT  LIGHT  AND  HEAT 

relieve  and  even  cure  poor  suffering  humanity  of  a  disease  at 
once  so  painful  and  possibly  dangerous  to  the  loss  of  hearing 
and  even  life  itself. 

"  I  do  not  contend  that  it  will  cure  all  cases  of  severe  in- 
flammation of  the  middle  ear  or  where  the  mastoid  has  become 
•affected,  needing  operative  relief.  But  if  the  light  could  be 
used  in  the  early  stages  it  would  abort  the  inflammatory  condi- 
tions in  most  cases." 

Carbuncles,  furuncles,  felons,  suppurative  tonsilitis,  and  all 
abscess  processes  in  the  early  stages  are  promptly  aborted  by 
essentially  the  same  procedures  as  that  employed  in  the  treat-' 
ment  of  otitis  media,  and  after  evacuation  when  the  presence 
of  fluctuation  indicates  it,  or  after  evacuation  by  the  natural 
method,  no  means  is  so  effective  in  restoring  the  conditions  to 
normal  and  removing  all  latent  infection  which  might  otherwise 
terminate  by  extension  of  infection  in  a  series  of  abscesses  or 
furuncles,  as  radiant  energy,  light,  heat,  the  Roentgen  ray  and 
high  frequency  current  systematically  employed. 

Another  method,  however,  may  be  indicated  in  the  first  36 
hours  of  pyogenic  infections,  i.  e.,  to  follow  a  prolonged  applica- 
tion of  radiant  energy  with  a  ten  minute  administration  of 
direct  static  vacuum  tube  current  (employing  the  same  connec- 
tions with  the  vacuum  tube  as  with  the  metal  electrode  with 
the  wave  current)  directly  to  the  indurated  area.  By  the 
effect  of  this  method  the  induration  is  dissipated  and  the 
phagocytes  get  at  the  germs  and  destroy  them  when  the  extent  of 
infection  is  small.  The  danger  of  this  method  is  in  letting  out 
the  infection  when  the  local  resistance  or  phagocytosis  is  not 
sufficient  to  overpower  the  vicious  element,  which  is  small 
indeed  in  the  early  stage. 

The  results  are  so  uniformly  successful  by  these  methods, 
that  in  but  rare  instances,  and  under  exceptional  conditions, 
is  failure  possible,  where  the  technique  is  properly  carried 
out. 

Tubercular  arthritis,  treated  with  the  x-ray  and  high 
frequency  currents  in  accord  with  the  rationale  enunciated,  is 
remarkably  relieved.  When  actual  destruction  of  parts  of 
the  joint  structure  has  not  taken  place,  the  prognosis  from 
energetic  treatment  along  the  lines  described,  together  with 
liberal  judicious  diet  and  approved  general  regime  is  good, 
and  the  chance  of  benefit  in  all  cases  is  assured. 


TREATMENT  OF  INFECTIOUS  PROCESSES      61 

In  tubercular  adenitis  the  same  regime  and  general  prognosis 
obtains.  The  writer's  method  of  treating  this  affection  is  to 
make  one  massive  x-ray  exposure  to  be  followed  after  24 
hours  by  light  and  the  high-frequency  vacuum  tube  applications. 
The  applications,  except  the  x-ray,  should  be  continued  daily 
until  all  evidence  of  infection  has  disappeared. 

Phlebitis. — There  is  probably  no  condition  in  which  greater 
and  more  prompt  relief  can  be  obtained  than  in  early  phlebitis  by 
the  combined  applications  of  radiant  light  and  heat,  followed  in 
each  instance  by  application  of  the  static  brush  discharge. 
The  writer  has  cured  six  cases  by  this  combined  method;  two 
in  cases  of  over  two  weeks'  standing,  and  the  others  of  shorter 
duration.  In  each  case  the  veins  became  patent  and  the  re- 
covery was  complete  after  from  three  days  to  two  weeks  daily 
treatment.  The  light  from  a  high  c.  p.  lamp  was  applied  for 
from  15  to  20  minutes,  followed  by  a  thorough  application  of 
the  brush  discharge  over  the  indurated  veins. 

Pelvic  Congestions. — Over  various  regions  of  tenderness  in 
the  lower  abdomen,  intense  local  light  and  heat  radiations 
afford  marked  relief  and  eventually  seemingly  relieve  some 
internal  conditions.  This  observation  is  pertinent  because  it 
is  the  experience  of  many  observers  that  radiant  light  and  heat 
increase  peristalsis,  the  bowels  being  frequently  stimulated  to 
movement  after  an  energetic  administration  of  light. 

Cleaves  has  also  employed  light  with  a  specially  devised  lamp 
per  vaginam  from  which  she  has  reported  favorably.* 

Orloff  of  Russia  and  Makarejev  have  also  reported  favor- 
able results  from  the  employment  of  white  light  to  the  pelvic 
tissues.  These  observations,  while  important  as  showing  the 
possibilities  of  light  therapy,  do  not  equal  in  point  of  efficiency 
the  applications  of  the  high  frequency  and  static  currents. 

Desloges  of  Montreal  reports  a  case  of  highly  congested  left 
ovary  in  a  neurasthenic  treated  by  20  minute  daily  applications 
of  light  from  a  high  c.  p.  incandescent  lamp,  applied  every  other 
day  for  two  weeks  when  the  condition  was  cured  and  three 
months  later  there  had  been  no  relapse. 

Curatulo  "  recommends  phototherapeutics  as  a  new  thera- 
peutical agent  in  obstetrics  and  the  diseases  of  women.  He 
describes  a  speculum  which  he  has  constructed  in  order  to  em- 

*  Cleaves,  "  Light  Energy,''  p.  55. 


62  RADIANT  LIGHT  AND  HEAT 

ploy  the  different  rays  separately  and  combined.  Therapeutic 
results  may  be  expected  in  cases  of  metritis  and  hypertrophy 
of  the  cervix,  in  cases  of  badly  developed  uterus  and  peri-  and 
para-metritic  exudates."  * 

Ozena  is  a  condition  difficult  of  treatment  by  light  and 
readily  and  effectively  treated  by  the  direct  static  and  high 
frequency  currents  with  vacuum  tube  electrodes,  but  some 
writers  have  reported  favorable  results  from  the  use  of  light 
reflected  into  the  throat  and  nasal  cavities. 

Diosurio  f  reports  16  cases  of  ozena  under  treatment  with  in- 
candescent light  reflected  into  the  nose  and  by  introducing  a 
water- jacketed  lamp  in  the  nose  or  a  larger  lamp  in  the  mouth. 
In  every  case  he  reports  a  noteworthy  "  decrease  of  the  waste 
and  secretion,  and  a  disappearance  of  the  characteristic  fetor." 

Cleaves  suggests  $  the  use  of  the  arc  light  "  in  treating  the 
nasal,  anal,  and  buccal  cavities ;  with  it  a  profounder  influence 
is  obtained,  involving  greater  tissue  reaction,  when  topically 
applied,  by  reaction  of  the  complex  chemical  frequencies." 

Post-Operative  employment  of  incandescent  light  is  one  of  the 
niceties  of  modern  surgery.  Radiant  light  and  heat  applied  a 
few  hours  after  an  operation  for  from  10  to  20  minutes  will 
remove  to  a  large  extent  the  diffuse  soreness  of  the  tissues, 
affording  the  patient  great  relief.  Applied  in  the  same  man- 
ner over  the  dressings  or  better  directly  to  the  bared  surface, 
it  will  promote  union  and  prevent  scarring  and  delayed  union. 
So  valuable  is  this  employment  of  radiant  energy,  that  it  should 
occupy  a  place  as  a  routine  practice  in  every  well  ordered 
hospital,  where  there  is  no  reason  that  patients  should  not  have 
everything  conducive  to  their  comfort,  and  a  recovery  in  the 
shortest  period  of  time. 

Post-Operative  Iritis. — A  specialist  reports  following  removal 
of  a  lens ;  five  days  after  the  operation  a  severe  iritis  occurred. 
"  An  exudate  filled  the  entire  pupillary  space,  and  organized 
secondary  membrane  formed;  and  vision,  which  was  good  on 
the  fourth  day,  was  reduced  to  the  barest  perception  of  strong 
electric  light.  At  first  atropin,  donin,  and  local  heat  were 
used  night  and  day  with  little  improvement,  when  an  incan- 

*  Brit.  Med.  Jour.,  October  n,  1902. 
f  Gag.  Med.  Ital.,  February  6,  1902. 
\  Cleaves,  "  Light  Energy,"  pp.  547-550. 


TREATMENT  OF  INFECTIOUS  PROCESSES      63 

descent  lamp  of  high  candle  power  was  installed  with  which 
the  patient  was  treated  every  four  hours  for  ten  minutes.  The 
relief  from  pain  was  prompt,  the  swelling  and  discoloration 
of  the  iris  changed  at  once,  improvement  setting  in  promptly. 
At  the  end  of  two  weeks  the  iris  had  recovered,  and  the  exudate 
and  secondary  membrane  had  been  reduced  to  the  extent  that 
a  secondary  operation,  usually  necessary  after  several  weeks, 
especially  following  iritis,  was  undertaken.  The  operation  was 
successful  in  opening  a  beautiful  black  pupil.  As  a  precau- 
tionary measure  the  lamp  was  used  a  few  days  following  the 
secondary  operation,  when  the  patient  was  discharged  with  no 
signs  of  iritis,  secondary  cataract,  or  other  untoward  result." 


CHAPTER  VII 
RADIANT  ENERGY  IN  DERMATOLOGY 

Radiant  energy  plays  an  important  role  in  the  treatment  of 
diseases  of  the  skin,  for  upon  this  superficial  organ  the  energy 
of  radiant  light  and  heat  are  largely  expended. 

Atonic  conditions  associated  with  infiltration  or  impaired 
metabolism,  or  infectious  processes  are  all  favorably  affected 
by  the  employment  of  radiant  light  and  heat  either  alone  or  in 
conjunction  with  high  potential  efHeuves,  static  brush-dis- 
charge or  vacuum  tube  applications  of  high-frequency  cur- 
rents. These  measures  act  by  increasing  local  hyperemia  and 
tissue  activity  with  restoration  or  increase  of  elimination,  af- 
fording trie  tissues  increased  nutrition  and  general  functional 
metabolism  and  removal  of  edema  or  infiltration. 

The  Roentgen  ray  in  certain  infectious  processes,  followed 
by  radiant  light  and  heat  after  the  requisite  degree  of  inhibition 
rfas  been  effected,  is  more  effective  in  infectious  and  malignant 
conditions  of  the  skin,  than  the  administration  of  radiant  light 
and  heat  alone.  In  some  infectious  processes,  particularly 
superficial  streptococcic  or  staphylococcic  processes,  the  early 
employment  of  radiant  light  and  heat  and  high-frequency  cur- 
rents will  be  effective. 

The  following  report  of  cases  and  methods  will  give  the  best 
idea  for  the  indication  of  methods  and  treatment  of  various 
skin  diseases. 

Varicose  ulcers. — The  pathological  condition  resulting  in 
varicose  ulcer  is  one  of  induration  and  edema  in  the  skin  and 
subcutaneous  tissue  in  which  the  parts  most  remote  from  the 
sources  of  nutrition  break  down  leaving  an  ulcerated  area, 
which  is  prone  to  increase  in  size  as  the  region  of  induration 
widens  and  becomes  more  impervious  to  the  circulation. 

The  indication  is  plainly  (i)  to  get  rid  of  the  induration; 

(2)  to  stimulate  active  local  metabolism  with  hyperemia,  and 

(3)  to  support  the  tissues  and  prevent  recurrence. 
Treatment — No  agent  known  to  the  writer  is  so  energetic 

in  removing  the  local  induration  and  tissue  infiltration  as  the 

64 


RADIANT  ENERGY  IN  DERMATOLOGY         65 

static  brush-discharge  applied  daily,  following  a  prolonged 
application  of  radiant  light  and  heat.  The  brush-discharge 
should  be  applied  each  "day  until  the  involved  tissues  are  well 
softened.  By  this  method  it  is  surprising  how  promptly  the 
process  in  early  cases  is  healed  and  with  perseverance  nearly 
all  cases  are  ultimately  healed. 

The  supportive  treatment  consists  in  the  firm  application  of 
an  elastic  bandage  over  a  splint  of  veneer  or  stiff  paste- 
board or  a  perforated  metal  shield;  the  surface  having  been 
dusted  with  bismuth  subnitrate  and  covered  with  a  thin  layer  of 
gauze  over  which  is  placed  one  thickness  of  absorbent  cotton. 
After  the  surface  is  healed,  a  firm  elastic  bandage  such  as  the 
crepe  velpeau,  an  English  production,  should  be  constantly 
worn  and  the  area  daily  massaged  to  prevent  recurrence. 

Case  i.  Miss  B.,  set.  thirty,  came  under  observation,  referred 
by  a  physician  in  a  neighboring  city,  with  a  varicose  ulcer 
which  had  been  increasing  in  size  for  more  than  a  year.  It 
was  circular  in  form  and  about  one  inch  in  diameter,  sur- 
rounded by  an  indurated  area  about  six  inches  in  diameter,  and 
surrounded  by  a  general  edema  below  the  knee.  Twenty-min- 
ute applications  of  intense  radiant  light  and  heat,  followed  by  a 
daily  energetic  application  of  the  static  brush-discharge  and 
the  employment  of  a  crepe  velpeau  bandage  applied  from  the 
toes  to  above  the  knee,  were  made  daily. 

When  treatment  was  instituted,  surrounding  the  ulcer  was 
a  margin  about  one  inch  in  width  of  livid  degenerated  skin  on 
the  verge  of  breaking  down,  which  rendered  healing  of  the 
ulcer  relatively  slow.  The  improvement  was  prompt  and  in 
six  weeks  the  surface  had  entirely  healed,  being  covered  with 
a  normal  skin.  This  patient  was  then  discharged  with  direc- 
tions to  continue  to  wear  the  bandage,  and  give  the  limb  a 
daily  massage,  removing  any  commencing  infiltration  or  hard- 
ening. 

Case  2.  Mr.  McD.,  set.  63,  came  under  observation  in  Janu- 
ary, 1908,  with  an  extensive  ulceration  of  practically  nine  years' 
duration  on  the  left  leg,  about  midway  between  the  knee  and 
foot. 

The  open  areas  were  one  large  ulcer  about  two  inches  in 
diameter  and  three  smaller  ones  around  it,  with  a  tissue  area 
fully  four  inches  in  diameter  about  to  break  down.  The  ex- 
tremity below  the  area  was  livid  and  cold,  resembling  Raynaud's 


66  RADIANT  LIGHT  AND  HEAT 

disease  and  the  leg  from  four  inches  below  the  knee  was  infil- 
trated, cold,  and  edematous.  The  second  toe  was  about  black, 
and  the  nail  separating.  The  extensors  of  the  toes  were  con- 
tracted to  the  extent  that  the  end  of  the  great  toe  and  the 
smaller  ones,  when  the  patient  stood  upon  them,  did  not  come 
to  within  three-quarters  of  an  inch  to  one  inch  of  the  floor.  On 
the  left  foot  one  inch  forward  of  the  external  malleolus  was  an 
ulcer  about  three-quarters  of  an  inch  in  diameter,  and  though 
not  so  generally  edematous,  the  foot  was  livid  and  cold,  with 
the  extensors  of  the  toes  contracted  as  on  the  right  leg. 

The  treatment  of  this  case  consisted  of  the  prolonged  daily 
application  of  radiant  light  which  was  manipulated  by  the 
patient  for  from  one-half  to  three-quarters  of  an  hour  daily, 
followed  by  thorough  application  of  the  static  brush-discharge 
which  removed  the  induration  daily.  The  surface  of  the  ulcer, 
which  was  inactive  and  of  a  venous  hue,  became  active  and  of 
an  arterial  hue  after  the  first  treatment,  indicating  the  opening 
up  of  the  arterial  channels  to  the  influx  of  blood  to  the  margins 
of  the  ulcer.  The  surface  was  dressed  each  time,  at  first  with 
vaseline  and  later  with  subnitrate  of  bismuth,  a  layer  of  gauze, 
a  layer  of  absorbent  cotton,  a  flexible  board  splint  large  enough 
to  protect  the  affected  surface,  and  over  all  a  crepe  velpeau 
bandage  extending  from  toes  to  knee.  The  small  ulcer  on  the 
reft  foot  was  healed  in  two  weeks  and  the  improvement  in  the 
large  one  was  marked  and  progressive  though  slow.  Treat- 
ment was  given  daily  except  Sundays  for  three  months  and  on 
alternate  days  for  the  following  two  months,  when  the  ulcera- 
tion  was  entirely  healed.  The  second  toe  and  feet  resumed 
normal  color  within  two  months.  A  healthy,  normally  vigor- 
ous nail  grew  upon  the  second  toe  of  the  right  foot,  and  con- 
tractures  of  the  extensor  muscles  of  the  feet  became  relaxed  so 
that  within  two  months  the  great  toe  came  normally  to  the 
level  of  the  foot. 

When  treatment  was  begun  the  patient,  who  for  months  had 
been  seated  in  his  room  with  his  foot  elevated,  came  once  in  a 
cab  and  afterwards  by  the  street  car,  being  rendered  com- 
fortable and  relatively  free  from  pain  at  once  on  the  institu- 
tion of  treatment.  This  patient  had  been  in  the  best  hands 
on  two  continents  for  five  years,  during  which  time  all  previ- 
ously recognized  methods  had  failed,  marking  it  as  one  of  un- 
usual severity. 


Plate  V. — Method  of  Treatment  with  the  London  Hospital  Lamp. 


RADIANT  ENERGY  IN  DERMATOLOGY         67 

Suppurating  Ulcer. — Dr.  J.  A.  Mohnson  reports  the  follow- 
ing case:  Male,  aet.  forty-five,  who  in  November,  1904,  ran  a 
barbed  wire  into  his  elbow,  which  was  neglected,  resulting  in 
a  chronic  infection.  In  September,  1905,  there  were  seven 
suppurating  ulcers  with  thickened  edges,  covering  a  surface 
six  inches  long  by  four  broad.  The  whole  surface  was  tender 
and  indurated  and  of  a  bluish  color.  The  condition  was 
treated  with  a  500  c.p.  incandescent  lamp,  exposures  twenty  to 
thirty  minutes  each,  the  lamp  brought  down  as  close  as  it  could 
be  borne,  with  an  occasional  "  hot  one  "  within  a  few  inches  of 
the  affected  surface.  In  all  seventeen  treatments  were  given. 
All  of  the  ulcers  were  healed  though  considerable  induration 
remained. 

Lupus  and  Allied  Conditions. — "  Rieder  of  Munich  says  that 
in  order  to  utilize  electric  arc  light  for  therapeutic  purposes  in 
skin  affections,  it  must  be  more  concentrated,  than  from  a  re- 
flector. This  was  first  overcome  by  Finsen  (1893).  Strong 
currents  and  concentration  of  the  light  by  quartz  lenses  as  well 
as  elimination  of  the  heat  rays  are  necessary  for  an  intense  ef- 
fect of  the  arc  light. 

"  There  has  always  been  a  tendency  to  create  new  light 
sources,  apt  to  produce  more  chemical  rays  than  the  old  sources 
do.  But  only  the  so-called  iron  lamps  have  been  of  any  ac- 
count. The  rays  of  the  iron  light  have  a  strong  irritating  and 
bactericidal  effect,  combined  with  moderate  heat-radiation,  but 
they  possess  very  little  of  the  quality  of  penetration.  There- 
fore deep-seated  affections  of  the  skin — for  instance,  lupus — are 
not  affected  by  this  light.  On  superficial  diseases  it  is  very 
effective. 

"  The  question,  whether  the  heat  rays  are  of  use  in  curing 
skin  diseases,  is  nowadays  generally  answered  in  the  affirma- 
tive, but  Rieder  is  skeptical  and  points  to  the  Finsen  method 
which  is  of  cold  light;  for  behind  the  water-cooled  compres- 
sion-lenses, there  is  nevertheless  heat  produced.  This  light 
seems  to  be  a  lucky  combination  of  light  and  heat  rays. 

"  It  is  absolutely  necessary  to  produce  a  slight  reaction  in 
the  skin  before  beneficial  results  may  be  expected.  There  are 
four  stages  of  reaction ;  hyperemia  of  the  skin,  painful  blister- 
ing, superficial  ulceration,  necrosis  with  the  formation  of 
ulcers."  * 

*  Wiener  med.  Presse,  44,  1903,  pp.  2074,  79. 


68  RADIANT  LIGHT  AND  HEAT 

"  Morris  and  Dove  compare  their  results  in  the  light  treat- 
ment in  lupus  and  other  diseases  of  the  skin  with  those  of  Fin- 
sen.  Finsen  gives  in  lupus  94  per  cent,  and  in  epithelioma 
50  per  cent,  cures.  The  results  of  Morris  and  Dove  are  not 
so  f  ai  orable.  From  65  cases  of  lupus  in  treatment  1 1  re- 
mained for  two  years  without  recurrence.  Improvement  took 
place  even  in  the  worst  cases.  They  used  for  the  skin  the 
Finsen  lamp  and  for  mucous  membrane  Roentgen  rays.  In  1 1 
cases  of.  lupus  erythematosus  7  remarkable  improvements  were 
recorded.  In  27  cases  they  improved  very  well.  Two  cases 
of  alopecia  did  not  improve.  Patients  should  be  kept  under 
observation  for  at  least  three  years."  * 

"  Moller  of  Stockholm  reports  results  of  phototherapeutic 
treatments  at  the  St.  Goran  Hospital.  Up  to  April,  1904,  were 
treated  113  cases;  79  cases  of  lupus  vulgaris,  17  lupus  ery- 
thematosus, 12  carcinoma  cutis,  3  alopecia  areata,  i  nevus  vas- 
culosus,  i  acne  rosacea.  In  the  lupus  cases  light  treatment 
proved  to  excel  all  other  methods.  Of  the  32  completed 
treatments  17  cases  were  cured,  10  almost  cured,  4  improved, 
i  hardly  influenced.  The  treatment  was  either  pure  light  treat- 
ment or  it  was  assisted  by  the  application  of  salves  or  galvano- 
caustic  puncture,  removal  of  tuberculous  glands,  etc.  In  cases 
of  lupus  erythematosus  the  infiltrated  forms  reacted  well,  while 
the  superficial  ones  showed  no  results.  Of  12  cases  of  skin 
carcinoma,  7  were  cured.  Two  cases  of  alopecia  areata  were 
cured."  f 

"  Schaltz  of  Berlin  contends  that  in  treating  lupus  vulgaris 
with  chemical  rays  the  heat  rays  play  a  conspicuous  part.  If, 
for  instance,  on  an  agar-layer  is  placed  a  Finsen  cooler  and 
through  this  is  illuminated  with  a  concentrated  electric  arc 
lamp,  the  agar-layer  will  melt  on  the  back-side,  but  not  on 
the  side  exposed  to  the  light  source.  From  this  and  other  ex- 
periments the  author  concludes,  that  the  cooling  of  the  skin  is 
only  superficial  and  that  the  heat  is  in  action  in  the  deeper 
layers."  $ 

"  Lesser  of  Berlin  reports  on  the  light  treatment  of  skin  dis- 
eases after  the  Finsen  method  and  says  that  two  qualities  of  the 
light  are  to  be  considered,  i.  e.,  the  tissue-destroying  and  hereby 

*  Practitioner,  1903,  April. 

fNorcisk  medicinsk  Arkiv.,  1904,  No.  10. 

i  Berl.  Win.  Woch.,  1904,  No.  18. 


RADIANT  ENERGY  IN  DERMATOLOGY         69 

inflammation-causing  quality  and,  secondly,  the  bactericidal 
quality  of  light.  In  fact,  those  two  qualities  are  combined  in 
one  and  the  same  process  when  certain  light  rays  destroy  a  cell 
in  the  human  body  or  when  they  kill  bacteria,  as  each  micro- 
organism is  nothing  else  than  a  living  cell.  The  more  a  method 
is  destroying  the  affected  without  attacking  the  healthy  c  ^11  the 
more  it  is  nearing  the  ideal  requirement.  At  the  University 
of  Berlin  are  used  Finsen  apparatus  of  30-40,000  candle  power 
(48-50  volts,  70-80  amperes)  mostly  in  the  treatment  of  lupus 
cases,  and  although  the  exact  results  are  not  yet  available,  the 
superiority  of  this  method  over  others  is  established."  * 

"  Teredde  reports  the  results  from  phototherapy  in  1 1  re- 
bellious cases  of  lupus  erythematosus  of  the  face.  Of  these  3 
were  cured,  2  were  benefited  to  a  marked  degree  and  passed 
from  under  treatment.  Of  the  6  patients  remaining  4  were 
being  cured  and  2  showed  no  improvement.  He  regards  this 
method  of  treatment  the  best  for  grave  forms  of  the  disease."  f 

"  Schamberg  of  Philadelphia  gives  his  results  in  treatment 
of  various  diseases  by  Finsen  light  and  Roentgen  rays. 

"  i.  Finsen  light  is  beneficial  in  the  treatment  of  lupus  vul- 
garis ;  but  large  lamps  are  required. 

"  2.  In  lupus  erythematosus  Finsen  light  effected  some  im- 
provement but  no  cures. 

"  3.  In  certain  cases  of  lupus  vulgaris  (ulcerated  nodules, 
when  mucous  membrane  of  nose,  lips,  or  mouth  is  affected) 
the  Roentgen  rays  are  preferable. 

"  4.  The  Roentgen  rays  have  certain  distinct  limitations  in 
the  treatment  of  cancer  of  the  skin,  when  not  deep-seated. 

"  5.  Roentgen  rays  are  very  valuable  in  acne. 

"  6.  Roentgen  rays  are  valuable  in  eczema. 

"  7.  Roentgen  rays  have  proved  beneficial  in  sycosis,  lichen, 
planus,  hypertrichosis,  ringworm,  and  favus  of  hairy  regions, 
tuberculosis  of  the  skin,  mycosis  fungoides,  etc."  $ 

"  Pick  and  Asahi  of  Prague  have  treated  after  the  method 
of  Tappeiner  and  Jesionek  12  cases  of  lupus,  2  cases  of  tuber- 
culosis cutis  verrucosa  and  ulcus  rodens,  5  cases  of  trichophy- 
tosis  and  3  cases  of  scrofuloderma.  The  affected  parts  were 
in  the  morning  brushed  with  one  per  cent,  solution  of  eosin  in  a 

*Zeit.  f.  Diat.  &  Phys.  Then,  Vol.  5,  1902,  pp.  449-457- 
f  Bui.  Gen.  de  Therap.,  January  23,  1901. 
$  American  Medicine,  December  19.  1903. 


70  RADIANT  LIGHT  AND  HEAT 

physiological  salt  solution.  During  the  day  these  parts  were 
repeatedly  moistened  with  a  salt  solution  in  order  to  avoid 
drying  in,  and  as  much  as  possible  exposed  to  the  sun;  over 
night  the  parts  were  covered  with  an  indifferent  salve  bandage. 
The  results  were  in  11  cases  very  encouraging.  In  cases  of 
lupus  the  inflammatory  infiltrations  receded  and  the  process 
of  cicatrization  made  fast  progress ;  the  cases  of  trichophytosis 
healed  in  a  few  days."  * 

Eczema  treated  by  radiant  energy  is  generally  effective  and 
in  other  cases  it  adds  greatly  to  the  efficiency  of  local  applica- 
tions. No  agent  is  so  efficient  in  the  writer's  experience  as  the 
local  application  of  the  static  brush-discharge  for  removing 
the  local  induration  or  infiltration  of  eczema  either  alone  or 
following  local  applications  of  radiant  light  and  heat ;  and  when 
persisted  in,  it  is  generally  effective.  Excellent  results  have 
been  effected  by  numerous  observers  from  the  use  of  radiant 
light  and  heat. 

"  Winternitz  of  Vienna  claims  to  have  proved  conclusively 
that  the  effects  of  sun  and  electric  light  are  not  simply  of  ther- 
mal character.  For  example,  the  elimination  of  the  chemical 
rays  with  a  transparent  red  material  is  sufficient  to  make  the 
high  temperature  in  an  electric  bath  endurable.  This  phenom- 
enon induced  Winternitz  when  applying  sun  baths  to  cover  tfie 
part  of  the  body  which  was  exposed  to  the  sun,  or  the  whole 
body,  with  red  cloth.  The  results  of  this  measure  were  diminu- 
tion of  chronic  skin  hyperemia,  anemization  of  hyperemic  por- 
tions of  the  skin,  improvement  and  cure  of  eczema."  f 

Desloges  reports  a  case  of  eczema  of  eight  years'  standing 
covering  much  of  the  body  to  which  for  several  weeks  high- 
frequency  currents  were  applied  to  the  hands  with  success.  To 
the  eruption  still  remaining  on  the  legs  and  surface  of  the  body 
generally  the  high  candle  power  incandescent  lamp  was  applied. 
The  redness  gradually  disappeared  and  the  scars  separated, 
leaving  the  skin  clear  and  in  a  normal  condition  after  three 
weeks.  The  applications  were  made  for  twenty  minutes  morn- 
ing and  evening.  Two  years  later  there  had  been  no  recur- 
rence. 

Eczema,  moist,  of  hands. — Dr.  Walter  of  Kramer,   Ind.,. 

*  Centr.  f.  d.  med.  Wissensch.,  43,  1905,  p.  158. 
f  Bericht.  u.  d.  22  off.  Versaml  dr.  Balneol.  Gessellsch.      Zu  Berlin,. 
7-21  Murz,  1901. 


RADIANT  ENERGY  IN  DERMATOLOGY         71 

reports  a  case  in  a  man  of  fifty  years.  First  attack  involving 
hands  and  wrists  with  severe  itching  and  exudation  of  serum 
from  cracks  and  fissures  made  no  improvement  from  wearing 
gloves  and  using  various  ointments,  not  washing  during  six 
weeks'  treatment.  After  two  weeks'  treatment  with  the 
leucodescent  lamp  every  night  he  made  a  complete  recovery. 
Improvement  was  noted  from  the  seventh  treatment.  This 
case  had  had  treatment  from  able  dermatologists. 

Psoriasis. — Dr.  Walter  of  Kramer,  Ind.,  reports  over  thirty 
cases  of  psoriasis  cleared  up  during  two  years  with  the  high 
candle  power  incandescent  lamp.  He  states  that  results  begin 
to  show  in  from  ten  to  twenty  daily  treatments,  and  that  thirty 
to  forty  treatments  extended  over  a  period  of  six  weeks  should 
be  given,  taking  an  hour  for  each  treatment  when  the  entire 
body  requires  treatment.  Under  this  plan  he  states  that  spots 
clear  up  in  the  center  and  become  more  pink  and  then  fade 
away.  Subsequent  treatments  when  small  spots  return  will 
keep  it  from  reappearing. 

He  emphasizes  the  statement  that  if  cases  are  treated  for 
from  six  to  eight  weeks  making  exposures  of  from  fifteen  to 
thirty  minutes  to  each  part,  cases  of  psoriasis  will  completely 
respond.  These  statements  are  made  from  an  experience  with 
from  thirty  to  fifty  cases  during  three  years  in  an  institution 
where  such  cases  congregate. 

Steiner  of  Leipzig  reports  results  in  electric  light  treatment. 
He  used  concentrated  arc  light  in  cases  of  furunculosis  and 
sycosis  barbae,  no  benefit.  In  cases  of  psoriasis,  the  results 
were  doubtful.  Cases  of  scabies  were  cured  with  three  appli- 
cations. Pityriasis  versicolor  disappeared  after  five  applica- 
tions. Prurigo  ceased  after  two  baths.  Grave  cases  of 
impetigo  were  cured  with  eight  baths.  Very  grave  cases  of 
chronic  dermatitis  were  cured  after  seventeen  applications. 
Cases  of  seborrheic  eczema  were  cured  after  four  baths. 
Chronic  eczema  was  cured.  Steiner  gives  the  clinical  history 
of  thirty-two  cases  confirming  his  claims.* 

Dr.  Charles  R.  Dickson  f  refers  to  the  use  of  the  iron  arc 
ultra-violet  lamp  in  the  treatment  of  a  number  of  conditions, 

*  Munich  med.  Woch.,  52,  1905,  pp.  748-51. 

f  "  Some  Aspects  of  Phototherapy,"  Journal  of  Advanced  Thera- 
peutics, January,  19x15. 


72  RADIANT  LIGHT  AND  HEAT 

maintaining  that  while  the  penetration  is  slight,  it  fills  a  place 
of  its  own  in  the  therapeutics  of  certain  skin  conditions. 

"  The  ultra-violet  rays,"  he  states,  "  have  a  marked  analgesic 
action.  This  was  very  clearly  manifested  in  an  extensive,  in- 
operable epithelioma  of  the  lower  lip  recurrent  after  excision, 
in  a  man  aged  57  years.  The  case  was  really  too  far  gone  for 
any  raying,  but  it  was  rayed  in  the  hope  of  retarding  somewhat 
the  progress  of  the  disease.  In  spite  of  all  that  was  done,  the 
tissues  were  breaking  down  extensively  and  there  was  much 
pain  in  the  lip.  Ultra-violet  rays  being  used  as  an  alternative, 
relieved  this  pain  so  that  the  patient  dropped  off  to  sleep  a  few 
minutes  after  the  first  time  they  were  employed,  and  there 
never  was  severe  pain  thereafter. 

"  Superficial  neuralgias  are  often  speedily  relieved  by  ultra- 
violet rays,  as  is  also  the  itching  of  epithelial  neoplasms,  benign 
as  well  as  malignant. 

"  The  atonic  action  of  the  iron  arc  rays  may  be  observed 
readily  when  they  are  employed  to  promote  rapid  healing  of 
superficial  abrasions,  for  instance,  on  the  hands  or  fingers  of 
surgeons  where  dressings  are  very  inconvenient,  and  an 
abraded  epidermis  is  a  constant  menace  to  safety.  In  such 
cases  it  is  rarely  necessary  to  repeat  an  exposure  of  ten  min- 
utes. All  signs  of  inflammation,  if  present,  will  usually  have 
passed  away  by  the  following  morning,  or  in  the  course  of  a 
few  hours  after  raying." 

He  also  treats  of  the  employment  of  the  ultra-violet  rays 
in  the  treatment  of  seborrheic  eczema,  in  which  after  prolonged 
treatment  no  permanent  result  was  obtained.  In  lupus'  ery- 
thematosus  some  benefit  was  obtained.  A  case  of  acne  rosacea 
on  the  nose  of  a  young  lady,  was  practically  cured  after  29 
treatments.  He  also  reported  its  employment  in  acne  vulgaris, 
chronic  eczema,  and  varicose  ulcers,  with  variable  results. 
Dickson  further  states  that  the  bactericidal  action  of  the  iron 
arc  rays  is  well  marked  in  sycosis,  in  the  treatment  of  which 
adrenalin  chloride  is  used  in  connection  with  the  employment 
of  the  rays  from  the  iron  arc  lamp,  the  lamp  being  held  about 
an  inch  away  from  the  hairs.  Five  treatments  of  ten  minutes 
each  effectually  removed  the  condition  in  ten  days. 

Another  evidence  of  the  bactericidal  action  of  the  rays  re- 
ported by  Dickson,  was  in  the  treatment  of  a  furuncle  on  the 
neck  of  a  boy  12  years  of  age.  The  treatment  was  made  fol- 


RADIANT  ENERGY  IN  DERMATOLOGY         73 

lowing  adrenalin  chloride  applied  to  render  the  tissues  anemic. 
The  swelling  was  remarkably  diminished  and  after  the  second 
raying  of  ten  minutes,  one  day  intervening,  the  furuncle  had 
disappeared. 

Excellent  results  were  also  quoted  in  the  early  treatment  of 
carbuncles  and  also  in  the  ulcerated  surfaces  following  the 
opening  of  the  abscess.  The  effects  of  these  rays,  the  writer 
states,  are  efficacious  in  superficial  lupus. 


CHAPTER  VIII 

RADIANT  LIGHT  AND  HEAT  IN  THE  TREATMENT 
OF  CONDITIONS  ASSOCIATED  WITH  FAULTY 
METABOLISM 

The  stimulating  and  tonic  effects  of  radiant  light  and  heat 
upon  general  metabolism  are  due  to  several  specific  actions  or 
effects  induced  on  the  tissues  in  the  circulating  fluids  of  the 
body. 

/.  The  actions  on  the  blood,  (i)  The  oxidizing  influences 
of  radiant  light  and  heat  favor  to  a  remarkable  degree  active 
tissue  metabolism.  (2)  The  oxygen  carrying  function  of  the 
blood  is  enriched  by  an  increased  percentage  of  hemoglobin 
due  to  the  direct  action  of  light  rays,  and  (3),  the  lymphatics 
are  rendered  more  active  in  eliminating  waste  products  and 
toxins  by  the  sweat  glands  and  other  emunctories  of  the  body. 

II.  The  superficial  end  organs  are  stimulated  to  a  greater 
activity  with  an  increased  tissue  change,  both  anabolic  and 
catabolic. 

///.  The  deep  spinal  centers  are  reflexly  stimulated  to 
greater  reflex  activity  by  the  intense  effects  of  the  applications 
of  radiant  light  and  heat  to  the  peripheral  neurons,  thereby 
arousing  greater  general  activity  of  the  vital  centers,  particu- 
larly the  perspiratory,  cardiac,  and  excretory  centers. 

IV.  The  general  diffusion  of  heat  which  takes  place  by 
convection  from  the  blood  heated  at  the  periphery,  promotes 
general    tissue    oxidation    and    elimination    throughout    the 
organism. 

V.  The  actinic  and  thermic  action  of  the  radiant  light  and 
heat  upon  the  germs  in  local  areas  of  infection,  causes  inhibition 
of  activity  and  destruction  of  the  germs  by  the  phagocytes, 
thereby  relieving  the  tissues  generally  from  the  toxic  materials 
otherwise  thrown  out. 

VI.  The  induction  of  superficial  hyperemia,  local  or  gen- 
eral, promotes  nutrition  in  the  tissues  by  an  increase  of  nutri- 
tious pabulum  distributed  through  the  tissues,  as  well  as  an 
increase  in  the  number  of  nature's  scavengers,  the  phagocytes, 

74 


IN  TREATMENT  OF  FAULTY  METABOLISM   75 

where  hyperemia  exists,  thereby  increasing  the  general  tissue 
resistance,  as  well  as  awakening  a  greater  metabolic  activity. 

VII.  The  stimulation  of  increased  elimination  through  the 
sweat  glands  and  other  emunctories,  induces  the  removal  from 
the  system  of  the  poisonous  toxins  which  vitiate  the  general 
system  and  cause  general  impairment  of  metabolism. 

The  actions  thus  instituted  by  the  systematic  employment  of 
radiant  light  and  heat,  it  will  be  readily  seen,  are  most  valuable ; 
because,  when  administered  in  a  technically  scientific  manner 
with  the  requisite  attention  to  details  of  administration,  they 
favor  the  elimination  of  waste  materials,  and  the  increased 
activity  of  general  and  local  metabolism  with  marked  increase 
of  oxidation  and  tissue  combustion,  generally  favorable  to  the 
establishment  of  the  normal  functions  of  the  body.  The  in- 
crease of  superficial  hyperemia  not  only  influences  the  insti- 
tution of  increased  local  tissue  resistance,  but  in  conditions  of 
impaired  kidney  functions  and  arteriosclerosis,  relieves  arter- 
ial tension  and  facilitates  the  elimination  of  the  waste  products 
through  the  skin,  which  the  impaired  kidneys  are  unable  to 
eliminate. 

In  all  forms  of  nephritis,  radiant  light  and  heat  are  indicated, 
and  offer  probably  greater  aid  in  relieving  the  system 
loaded  with  nitrogenous  waste  products  than  other  therapeutic 
measures.  In  parenchymatous  nephritis,  particularly,  radiant 
light  and  heat  afford  a  remarkable  means  of  relief.  Cases 
which  have  failed  to  yield  to  medicinal  or  other  physical  treat- 
ment, when  placed  under  the  systematic  employment  of  radiant 
light  and  heat,  have  been  effectually  relieved  and  cured.  The 
treatment  of  parenchymatous  nephritis  by  radiant  light  and 
heat  should  be  carried  out  under  a  thorough  regime.  The 
full  light  baths  should  be  given  daily  for  periods  of  20  to  30 
minutes,  preferably  with  the  patient  reclining  in  the  bath  cab- 
inet. A  greater  degree  of  diaphoresis  is  induced  in  the  cabinet 
owing  to  the  accumulation  of  convective  heat.  Diaphoresis  is 
not  the  chief  indication  conserved,  but  favors  the  elimination 
of  a  larger  quantity  of  nitrogenous  products  through  the  skin. 
The  reflex  effect  of  the  heated  blood  upon  the  spinal  centers 
favors  the  relief  of  general  tension  and  engorgement,  and  pro- 
motes the  restoration  of  the  normal  function  of  the  kidneys. 
The  added  employment  of  the  static  wave  current  over  the  kid- 
neys further  favors  the  relief  of  local  engorgement. 


76  RADIANT  LIGHT  AND  HEAT 

The  elimination  of  toxins,  often  the  active  cause  of  paren- 
chymatous  nephritis,  as  present  following  diphtheria,  nephri- 
tis, and  other  infectious  conditions,  favors  the  restoration  of 
the  kidney  function,  and  also  relieves  other  parts  of  the  organ- 
ism, unfavorably  affected  by  the  presence  of  toxic  material 
in  the  fluids  and  sluggish  recesses  of  the  body  as  often  occurs 
following  attacks  of  local  infection,  when  it  would  seem  that 
the  phagocytes  engorged  with  the  pyogenic  bacteria,  had  be- 
come lodged  in  the  regions  of  imperfect  circulation  as  in  the 
joints,  setting  up  a  local  inflammatory  process  as  present  in 
various  types  of  infectious  arthritis. 

Infectious  arthritis  or  so-called  rheumatism,  and  conditions 
which  have  been  considered  as  allied  to  rheumatism,  are  un- 
doubtedly due  to  the  influences  of  toxic  infection  arising  from 
some  active  site  of  germ  proliferation  either  present  in  the 
alimentary  canal,  or  elsewhere  in  the  tissues,  as  in  the  seminal 
vesicles  in  cases  of  gonorrheal  arthritis.  The  older  notion  that 
germs  themselves  were  locally  present  and  affecting  the  local 
inflammatory  processes,  seems  to  have  been  generally  dis- 
proved. 

With  the  above  premises  accepted,  it  is  evident  that  the  first 
indication  is  to  stop  the  pyogenic  or  other  bactericidal  process 
either  by  the  induction  of  local  hyperemia,  by  means  of  an 
increase  of  local  phagocytosis,  or  by  the  employment  of  intes- 
tinal or  other  local  antiseptic  measures  to  destroy  the  germ 
in  situ.  Another  indication  is  to  promote  as  rapidly  as  possible 
the  elimination  of  the  toxins  from  every  part  of  the  body, 
which  is  best  effected  either  by  the  use  of  a  general  light  bath 
with  as  high  a  temperature  as  can  be  borne,  or  the  employ- 
ment of  the  body  dry  hot  air  bath.  That  the  light  bath  pos- 
sesses a  greater  energy  than  dry  heat  in  the  treatment  of  gen- 
eral infection,  is  probably  due  to  the  fact  that  the  actinic  action 
of  light  upon  the  blood  is  added  to  the  thermic  effects.  Fur- 
thermore, the  light  radiated  upon  the  surface  of  the  body,  as 
explained  elsewhere  in  this  volume,  penetrates  to  stimulate 
tissues  to  greater  depth  than  with  the  application  of  convective 
heat  alone;  whereas,  with  the  radiant  light  and  heat  bath  cab- 
inet both  radiant  light  and  heat,  and  convective  heat,  influence 
by  stimulation  of  the  emunctories  the  elimination  of  waste 
products.  The  only  advantage  that  can  be  demonstrated  of 
convective  heat  applications,  is  from  the  fact  that  the  body 


IN  TREATMENT  OF  FAULTY  METABOLISM   77 

wrapped  in  Turkish  toweling  which  takes  up  the  moisture 
which  congeals  upon  the  surface,  will  stand  a  degree  of  tem- 
perature above  the  boiling  point  without  blistering  the  surface 
of  the  body,  as  is  certain  to  occur  if  too  high  temperatures  are 
otherwise  employed. 

The  general  indications  are  practically  the  same  where  a 
general  toxemia  exists  with  a  tendency  to  an  involvement  of 
joint  or  other  structures  in  remote  parts  of  the  body ;  whereas, 
in  cases  of  local  septic  infection,  as  stated  elsewhere,  the  local 
employment  of  convective  heat  seems  the  most  practical  means 
of  effecting  the  destruction  of  the  infection  (see  convective 
heat  in  septic  infection  on  page  98). 

In  arteriosclerosis  two  important  points  for  consideration 
are  present:  (i)  the  correction  of  those  conditions  or  habits  of 
life  and  diet  which  lead  to  toxemia ;  conditions  which  seem 
to  superinduce  arterial  hypertension,  and  (2)  the  elimination 
of  toxic  materials  which  are  retained  in  the  system. 

Dr.  T.  D.  Crothers  called  attention  to  the  importance  of 
radiant  light  and  heat  in  the  treatment  of  arteriosclerosis  in 
a  paper  published  in  1905,*  in  which  he  stated  that  "  frequently 
the  use  of  drink  and  drugs  are  symptoms  as  well  as  causes  of 
those  pathological  conditions.  Always  associated  with  it  are 
toxic  states  with  defective  elimination,  local  congestion,  and 
palsies  of  the  vaso-motor  nerve,  and  with  defective  nutrition 
and  elimination,  there  is  starvation  and  poisoning. 

"  The  radiant  light  bath  by  this  specific  sudorific  action, 
appears  to  have  a  marvelous  effect  on  the  elimination  of  the 
toxins,  and  the  stimulation  of  the  vaso-motor  centers  also 
influences  metabolism." 

He  quotes  cases  in  which  he  has  demonstrated  beyond  ques- 
tion the  efficacy  of  the  radiant  light  bath  in  the  treatment  of 
arteriosclerosis.  In  another  paper  published  in  the  Journal  of 
Advanced  Therapeutics  for  December,  1906,  "  in  control  ex- 
periments with  healthy  patients,  the  tension  is  generally  low- 
ered. ...  In  a  person  with  high  arterial  tension  and  a 
regular  heart  action,  together  with  the  static  breeze,  radiant 
light  and  the  shower  after,  there  is  a  falling  of  the  tension  and 
an  improvement  of  the  action  of  the  heart." 

Experiments  made  by  the  writer  in  conditions  of  high  arte- 

*  Radiant  Light  Bath  in  Arteriosclerosis,  Advanced  Therapeutics,  August, 
1905. 


78  RADIANT  LIGHT  AND  HEAT 

rial  tension,  have  demonstrated  a  uniform  fall  of  from  5  to  10 
mm.  with  the  modified  Riva  Rocci  sphygmomanometer,  from 
a  prolonged  application  of  radiant  light  and  heat  from  a  500 
c.p.  incandescent  lamp,  which  effect  is  undoubtedly  due  to  two 
influences — to  capillary  dilatation  of  the  smaller  superficial 
arterioles  and  capillaries,  and  the  relief  of  the  system  from  a 
certain  amount  of  toxic  materials  with  perspiration. 

The  treatment  of  arteriosclerosis  should  not  be  confined  to 
the  employment  of  light,  as  the  regulation  of  diet,  and  the 
use  also  of  high  frequency  auto-condensation,  the  last  of 
which  promotes  a  large  degree  of  tissue  combustion  and  elim- 
ination, play  an  important  role  in  the  treatment  of  this  condi- 
tion. If  taken  early  in  hand  by  careful  attention  to  habit  and 
regime,  arteriosclerosis  can  be  effectually  controlled  and  pre- 
vented in  most  cases.  The  employment  of  light  in  these  cases, 
however,  should  always  constitute  a  part  of  a  well  regulated 
regime  in  the  treatment  of  arteriosclerosis.  All  conditions 
associated  with  impaired  nutrition,  as  anemia,  leukemia,  per- 
nicious anemia,  leucocythemia,  rheumatoid  arthritis,  peripheral 
defects  of  metabolism  associated  with  spinal  cord  affections, 
and  the  functional  neuroses,  in  all  of  which  conditions  there  is 
a  lessening  of  the  local  resistance  of  the  tissues  with  a  relative 
degree  of  defective  local  or  general  metabolism,  are 
always  benefited  by  any  agency  which  will  stimulate  an  in- 
creased blood  supply  co-incident  with  increase  or  stimulation 
of  end-organ  metabolism.  It  is  therefore  a  matter  of  much 
importance  in  the  general  recognition  of  the  advantages  of 
these  important  therapeutic  agencies,  that  they  should  be  ap- 
preciated in  the  treatment  of  all  conditions  associated  with 
impaired  metabolism,  local  or  general.  This  systematic  em- 
ployment, in  conjunction  with  other  physical  methods  and 
dietetic  regulation,  is  indicated  in  all  such  cases.  So  important 
is  the  employment  of  radiant  light  and  heat  as  a  daily  regime 
in  the  management  of  these  cases,  that  its  employment  is  cer- 
tain to  become  a  general  routine  practice  as  important  as  the 
shower  bath  in  the  home  under  the  direction  of  the  family 
physician.  The  light  bath  must  become  in  the  well  regulated 
household  of  all  those  who  can  afford  it,  a  part  of  the  daily  life 
regime  for  those  who  are  suffering  from  impaired  metabolism 
or  would  employ  it  as  a  prophylactic  against  the  inroads  of 
disease. 


IN  TREATMENT  OF  FAULTY  METABOLISM   79 

It  is  an  undoubted  fact  that  the  business  man  or  woman  and 
the  housewife  who  are  confined  within  a  home  or  office  during 
the  larger  part  of  the  day,  and  who  when  in  the  open  are 
clothed  in  thick  garments  opaque  to  light,  fail  to  receive  the 
requisite  amount  of  sunlight  to  properly  maintain  a  normal 
physical  status.  For  this  reason  the  general  use  for  a  short 
time  daily  of  the  electric  light  bath  in  the  home,  should  be 
encouraged.  It  should  be  adopted  as  a  prophylactic  measure, 
or  for  the  relief  of  conditions  of  impaired  metabolism,  but 
should  not  preclude  the  necessity  of  the  regulation  of  other 
hygienic  measures,  particularly,  careful  attention  to  the  diet 
of  the  individual. 

Until  such  time  as  the  community  shall  be  educated  to  the 
importance  of  these  things,  the  profession  must  employ  radiant 
light  and  heat  in  the  treatment  of  many  of  their  cases;  for  it 
will  not  be  possible,  in  the  face  of  the  importance  of  these 
measures,  to  conscientiously  manage  the  treatment  of  diseased 
conditions  in  which  the  indication  for  the  employment  of 
radiant  light  and  heat  is  so  apparent  without  either  the  institu- 
tion of  the  means  in  the  practitioners'  office,  or  their  direction 
to  their  patients  to  go  elsewhere. 


CHAPTER  IX 

OPPOSITE    EFFECTS    OF    RADIANT    LIGHT    AND 
HEAT  AND  THE  ROENTGEN  RAY 

The  study  of  the  different  forms  of  radiant  energy  reveals  a 
variety  of  action  and  effect  which  indicates  a  diversity  of  appli- 
cation to  therapeutics.  The  relation  of  the  frequency  of  vibra- 
tion to  penetration,  the  degree  of  penetration,  diminishing  as 
the  frequencies  increase,  until  the  higher  frequencies  of  the 
Roentgen  ray  are  reached,  regulates  the  therapeutic  indications. 

"  It  was  predicted  by  Helmholtz,  the  great  mathematician," 
says  Sir  Oliver  Lodge,  "  that  if  waves  could  exist  still  smaller, 
you  would  ultimately  get  waves  smaller  than  the  atoms,  and  that 
then,  instead  of  being  bent  more,  would  be  bent  less ;  and  in  that 
way  we  should  have  the  upper  part  of  the  spectrum  with  dis- 
persion reversed — the  spectrum  at  last  folding  back  upon  itself, 
until,  you  come  to  the  ultimately  small  waves,  they  would  not 
be  bent  at  all,  but  would  go  straight  on.  The  prediction  was 
fulfilled  in  the  x-ray,  which  is  not  refracted,  but  goes  straight 
on,  and  is  constituted  of  the  shortest  wave-lengths,  excessively 
rapid,  and  waves  smaller  than  anything  conceived  before.  Ful- 
filling the  theory  of  Helmholtz  these  rays  go  straight  on." 

It  was  observed  by  the  writer  in  a  paper  published  by  him,* 
that  a  remarkable  contrast  exists  between  the  ultra-violet  and 
the  x-ray.  The  latter,  of  varying  wave-lengths,  are  not  sorted 
out  from  one  another — are  not  refracted,  but  go  straight  on 
without  any  deviation  whatever. 

Sir  Oliver  Lodge  describes  the  x-ray  as  follows :  "  It  is 
simply  a  solitary  wave,  a  solitary  pulse,  up  and  down  almost 
instantaneously,  and  no  more;  nothing  continuous,  not  a  suc- 
cession of  waves — a  solitary  pulse,  one  splash  like  a  whip- 
crack,  just  again  and  again.  With  every  blow  of  an  electron 
the  derived  x-rays  proceed  from  the  target  in  very  rapid  suc- 
cession, in  all  these  flashes  or  cracks,  because  the  electrons  or 
cathode  rays  are  bombarding  the  target  in  very  large  numbers." 

* "  Comparison  of  Forms  of  Radiant  Energy,"  Archives  of  the 
Roentgen  Ray  for  December,  1906. 

80 


OPPOSITE  EFFECTS  OF  ROENTGEN  RAY       81 

It  will  be  readily  seen,  therefore,  that  the  characteris- 
tics of  the  Roentgen  ray  differ  materially  from  those  of  radi- 
ant light  and  heat  radiations,  both  as  to  wave-length  and 
the  method  of  discharge  or  irradiation,  which  from  a  physical 
point  of  view  accounts  for  their  different  action  upon  the  tis- 
sues. The  effect  must  be  looked  at  also  from  another  point 
of  view  with  reference  to  their  impingement  or  absorption  by 
the  tissues.  In  the  matter  of  radiant  light  and  heat  rays,  they 
do  not  pass  through  dense  and  deep  tissues,  their  energy  being 
spent,  when  they  have  each  passed  to  depths  relative  to  their 
wave  lengths.  While  the  penetrations,  particularly  the  lower 
frequencies,  are  considerable,  they  are  generally  absorbed  before 
passing  through  the  body  upon  which  they  impinge,  while  the 
x-rays  pass  through.  It  must  also  be  taken  into  consideration 
that  the  density,  or  volume,  of  these  radiations  from  the 
usual  sources  of  radiant  light  and  heat  is  very  much  greater 
than  from  the  usual  sources  of  the  x-ray.  The  heat  effect, 
therefore,  of  the  forms  of  radiant  light  and  heat,  is  pronounced 
whereas  a  large  percentage  of  the  radiations  from  a  modified 
Crookes  tube  pass  directly  through  the  tissues  producing  rela- 
tively little,  if  any  heat  from  the  effects  of  absorption,  or  spent 
energy.  Another  factor  must  be  taken  into  account  with  refer- 
ence to  these  radiations — the  effect  of  passing  through  the  tis- 
sues in  the  interspaces  between  the  cells,  as  suggested  by  Helm- 
holtz,  and  confirmed  by  Sir  Oliver  Lodge,  would  be  liable  to 
produce  an  effect  upon  the  cell  bodies ;  because  the  other  ethereal 
vibrations,  as  evidenced  by  the  effects  of  radiant  light  and  heat, 
possess  an  energy  within  themselves,  capable  of  affecting  cell 
protoplasm.  It  is  probable,  on  account  of  the  intense  rapid 
vibration  of  the  penetrating  Roentgen  rays,  that  they  pro- 
foundly affect  cell  protoplasm,  as  first  observed  in  a  previous 
work  of  the  writer  *  in  which  the  Physiological  Effects  of  the 
Roentgen  ray  were  considered  as  follows : 

"  The  study  of  the  actions  of  the  x-ray  is  the  study  of  the 
effects  of  a  form  of  vibration — agitation  of  the  ether  of  the 
highest  recognized  intensity.  It  is  an  invisible  force,  and,  like 
other  invisible  forms  of  vibration,  can  only  be  comprehended 
by  the  effects  arising  from  its  actions. 

"  The  physical  characteristics  are  as  follows : 

*  "  Static  Electricity  and  the  Uses  of  the  Roentgen  Ray,"  p.  220. 


82  RADIANT  LIGHT  AND  HEAT 

"  I.  They  penetrate  many  substances  which  absorb  the  visible 
rays  of  the  spectrum. 

"  II.  They  are  refracted  *  when  passing  from  one  medium  to 
another  of  different  density,  but  very  slightly. 

"  III.  They  are  but  slightly  reflected,  and  are  absorbed  by 
substances  which  they  do  not  penetrate,  and  cause  others  to 
fluoresce. 

"  IV.  What  the  peculiar  effects  of  the  rays  may  be  upon  the 
protoplasmic  structures  of  the  body  as  they  pass  through  the 
tissues  can  only  be  determined  from  the  conditions  arising, 
which  are  as  follows : 

"  ( i )  As  one  stands  before  the  radiating  tube  with  the  rays 
penetrating  the  body,  there  is  little  perceptible  sensation.  It 
may  have  been  noticed,  however,  if  the  hand  be  held  before  the 
tube  for  several  minutes  that  a  sensation  of  gentle  contraction 
of  the  skin  is  perceptible.  The  statement  of  this  fact  is  not 
uncommonly  made  by  patients  under  treatment  by  the  x-ray, 
and  it  is  so  from  the  writer's  personal  observation. 

"  (2)  It  is  also  observed  that  the  surface  of  an  ulcerating 
cancerous  growth  appears  as  if  glazed  or  as  covered  with  a 
thin  coating  of  collodion  after  an  exposure  of  several  minutes. 

"  (3)  The  substance  of  a  growth,  when  standing  promi- 
nently above  the  surrounding  surfaces,  is  also  perceptibly  con- 
tracted. 

"  (4)  Following  a  series  of  exposures  it  has  been  observed 
by  all  familiar  with  the  subject  that  the  skin  becomes  atrophied, 
and  the  hair  follicles  and  sweat  glands  become  inactive — hair 
falling  out  and  secretion  of  sweat  ceasing. 

"  (5)  Pain  is  in  most  cases  relieved  to  a  remarkable  extent 
after  a  few  exposures  in  various  inflammatory  and  malignant 
conditions. 

"  (6)  Congestion  is  evidently  diminished,  as  is  indicated  by 
the  relief  of  conditions  which  could  be  explained  under  no  other 
hypothesis,  occurring,  as  it  does,  when  inflammatory  conditions 
are  exposed  to  the  influence  of  the  rays. 

"  (7)  Long  or  repeated  short  exposures  produce  dermatitis 
and  necrosis,  deep  or  superficial,  according  to  the  length  of 
exposure. 

"  The  above  propositions,  jointly  and  severally,  point  strongly 

*  Recent  convincing  reports  affirm  that  the  x-rays  are  slightly  re- 
fracted, contrary  to  Roentgen's  first  statement. 


OPPOSITE  EFFECTS  OF  ROENTGEN  RAY      83 

to  one  effect  in  particular,  which  accounts  for  all — the  con- 
traction of  cell  protoplasm.  The  sense  of  contraction  of  the 
normal  skin,  the  glazing  and  contraction  of  an  ulcerated  sur- 
face, the  atrophy  of  the  skin,  and  the  relief  of  pain  and  conges- 
tion are  all  indicative  of  tissue  contraction.  Indeed,  it  is  the 
most  plausible  explanation  of  the  impaired  nutrition,  for  necro- 
tic  and  sloughing  tissue,  normal  or  diseased,  betokens  a  dimin- 
ished blood  supply — local  anemia ;  due  as  a  consequence  of  the 
contraction  of  the  muscular  coats  of  the  vascular  system. 
Whether  the  action  is  the  influence  upon  the  end  plate  of  the 
neurons  or  upon  the  individual  cells  it  would  be  difficult  to 
assert;  but  the  latter  is  most  probable." 

The  writer  in  a  former  contribution  *  presented  a  statement 
of  the  results  of  the  action  based  upon  clinical  observation: 
"  That  the  effects  of  the  x-ray  upon  the  normal  tissue  are  (i) 
to  induce  normal  activities,  due  to  the  vibratory  effect  of  the 
rays,  or  of  the  ether  in  the  presence  of  the  rays.  (2)  That 
these  effects  with  short  exposures  at  proper  distances  with  high 
vacuum  tubes  induce  activity  of  normal  tissue  cells,  which,  in 
some  cases,  supplant  abnormal  tissue  elements  without  evi- 
dences of  disintegration.  (3)  That  exposures  destroy  only  the 
abnormal  tissues  unless  they  be  too  prolonged.  (4)  That  ab- 
normal tissue  thus  exposed  breaks  down  and  disappears  through 
the  natural  channels  of  absorption  or  by  sloughing."  It  has 
been  shown  in  the  writer's  experience  that  tissues  of  low 
vitality  are  always  the  first  to  break  down. 

"  It  is  probable  that  the  vitality  of  all  tissue  is  lowered  by 
cutting  off  the  blood  supply  as  well  as  by  inhibition  induced  in 
the  cells.  Naturally,  under  such  circumstances,  tissues  of  low 
vitality  are  the  first  to  break  down.  It  is  also  well  established 
that  the  tissues  of  debilitated  patients  do  not  resist  the  destruc- 
tive action  of  the  rays  as  do  those  of  normal  individuals,  which 
confirms  the  theory. 

"  It  has  also  been  demonstrated  that  malignant  tumors  in  the 
aged  or  infirm  are  more  likely  to  soften  and  break  down  than 
in  normal  individuals,  which  confirms  the  view  that  when,  for 
any  reason,  the  tissue  resistance  is  lowered  the  tissues  break 
down.  The  violent  toxemia  occurring  under  such  conditions  is 

*  "  The  Uses  of  the  X-ray  and  Accessory  Measures  in  the  Treatment 
of  Diseases  of  the  Skin,"  JOURNAL  OF  ADVANCED  THERAPEUTICS,  June, 
1903. 


84  RADIANT  LIGHT  AND  HEAT 

not  due  to  extension  of  the  malignant  process,  but  to  the  auto- 
infection  arising  from  absorption  of  toxins  present  in  the 
broken-down  structures. 

"  This  effect  upon  circulation  and  nutrition  when  employed 
to  the  extent  of  destroying  malignant  growths  is  at  best  a  dan- 
gerous one,  and  demands  careful  attention  to  the  management 
of  details  and  a  knowledge  of  their  consequences. 

"  The  cumulative  action  is  a  striking  feature  of  the  effects  of 
the  rays  and  demonstrates  the  more  or  less  persistent  condition 
of  contraction  which  follows  a  series  of  exposures  and  explains 
the  diminished  metabolism  after  long  exposures  or  series  of 
exposures. 

"  It  would  seem,  therefore,  that  the  logical  explanation  of 
the  action  of  the  x-ray  when  nearby,  prolonged,  or  frequent 
administrations  are  given  is,  that  the  exposed  structures  con- 
tract at  the  expense  of  nutrition  and  produce,  when  carried  to 
a  certain  degree,  necrosis  of  the  part.  This  theory  accords  with 
the  therapeutic  results  obtained  from  nearby  and  prolonged  ex- 
posures. 

"  The  stimulating  or  tonic  effect  of  the  Roentgen  ray,  in- 
duced by  short  exposures  or  with  a  high-vacuum  tube  at  dis- 
tances of  sixteen  to  twenty  inches  from  the  anti-cathode,  is 
probably  due  to  the  disposition  of  the  vibratory  influences  of 
the  rays  both  to  overcome  local  stasis,  restoring  tone  to  the 
muscular  coats  of  the  arterioles,  and  at  the  same  time  to  induce 
a  more  active  local  metabolism. 

"  A  knowledge  of  the  action  of  all  stimulants  teaches  that 
their  employment  must  be  judicious  or  the  opposite  effects  will 
result.  So  with  the  x-ray,  to  obtain  the  tonic  action,  exposures 
must  be  infrequent  (not  oftener  than  twice  weekly),  with  pene- 
trating rays  emanating  from  a  tube  usually  at  a  distance  of 
from  twelve  to  twenty  inches.  The  length  of  exposures  under 
these  circumstances  may  be  for  the  usual  period  of  ten  minutes." 

The  inhibitory  actions  from  prolonged  exposures  are  effects, 
which  we  are  considering  as  antagonistic  to  the  stimulating 
effects  of  radiant  light  and  heat  from  short  or  prolonged  ex- 
posures. The  stimulating  effects  of  the  Roentgen  ray  as  re- 
ferred to  are  not  generally  employed  for  the  reason  that  the 
other  forms  of  radiant  energy  best  conserve  that  purpose. 
These  views  expressed  by  the  writer  in  1904  have  been  in  the 
experience  of  many  observers  verified ;  and  while  to  the  present 


OPPOSITE  EFFECTS  OF  ROENTGEN  RAY      85 

time  no  other  definite  physiological  effects  have  been  published, 
the  general  consensus  of  opinion  is  drawing  to  the  recognition 
of  the  part  contraction  of  protoplasm  plays. 

Since  these  observations  were  made,  it  has  been  further 
demonstrated  that  the  tissue  inertia  induced  from  the  inhibitory 
action  of  the  Roentgen  ray,  points  to  another  very  significant 
effect,  which  is  likewise  best  explained  by  the  condition  of 
tissue  inertia  following  the  profound  effects  upon  protoplasm, 
in  response  to  trie  intense  vibratory  influence  of  the  penetrating 
rays ;  that  is,  the  effect  upon  the  procreative  functions  in  mam- 
mals as  well  as  in  the  lower  forms  of  germ  life.  This  fact  was 
referred  to  by  the  writer  in  an  editorial  *  on  "  The  Actions  of 
the  X-ray  upon  Animal  Tissues,"  as  follows : 

"  The  physical  characteristics  of  the  x-ray,  as  generally  ac- 
cepted by  physicists,  precludes  the  acceptation  of  the  idea  of 
ionization  or  that  the  rays  possess  any  electrical  qualities,  except 
peculiar  characteristics  which  can  be  derived  from  no  other 
source.  They  are  lines  of  longitudinal  ether  vibration  (not 
Hertzian  waves)  transmitted  in  straight  lines  from  a  source  of 
great  energy,  possessing  qualities  whereby  they  penetrate  solid 
bodies  indicating  an  expenditure  of  the  energy  derived,  which 
may  be  either  entirely  spent  upon  bodies  of  too  great  density  or 
absorbed  in  varying  degrees  in  their  passage  through  objects  of 
different  densities.  Under  the  laws  of  conservation  of  energy 
when  projected  against  animal  tissue  this  force  is  spent  upon 
the  tissues,  exerting  characteristic  influences — the  effects  of  the 
x-ray. 

"  There  are  three  hypotheses  upon  which  the  results  of  these 
exposures  which  are  so  little  appreciated  by  the  profession 
to-day,  might  be  explained,  (i)  It  is  probable  that  cell  pro- 
toplasm is  affected  by  the  stimulating  action  of  these  energetic 
lines  of  vibration  to  a  state  of  contraction  that  suspends  activity 
in  varying  degrees  depending  upon  the  duration,  frequency,  or 
intensity  of  the  exposures.  Under  this  hypothesis  nutritive 
processes  would  be  suspended  by  lessening  or  discontinuance 
of  the  metabolic  processes  and  at  the  same  time  by  diminishing 
or  cutting  off  the  local  blood  supply  owing  to  the  contraction 
of  the  cells  which  comprise  the  muscular  coats  of  the  arteries. 
In  this  connection  it  is  a  well  authenticated  fact  that  the  action 

*  ADVANCED  THERAPEUTICS,  March,  1905. 


86  RADIANT  LIGHT  AND  HEAT 

of  the  ray  is  cumulative,  that  the  extreme  degree  of  physio- 
logical effect  is  not  reached  except  the  exposure  is  prolonged  or 
of  great  volume  or  intensity,  or  at  the  termination  of  a  series 
of  exposures. 

"  (2)  It  is  possible  that  only  the  neurons  are  stimulated  re- 
sulting in  the  effects  upon  metabolism  and  the  circulation  as 
above  described.  It  is  doubtful,  however,  if  such  stimuli 
would  only  affect  the  vasomotors. 

"  (3)  It  would  be  tenable  and  account  for  most  of  the  results 
that  the  effects  are  induced  by  the  contraction  of  muscular 
cells. 

"  The  former  hypothesis  is  the  most  probable  because  it  bet- 
ter explains  the  various  actions  of  this  remarkable  agent.  It 
is  the  induction  of  cell  contraction  with  the  effects  of  suspen- 
sion of  animation,  of  activity,  of  function,  of  metabolism. 
These  results  would  obtain  from  the  effect  upon  protoplasm 
above  suggested,  and  seem  to  explain  every  consequent  action 
of  the  rays  upon  animal  tissue. 

"  It  will  be  observed  by  those  familiar  with  the  x-ray  that  the 
bulk  of  a  superficial  tumor  exposed  to  the  x-ray  will  be  appre- 
ciably contracted  after  an  exposure;  that  a  surface  moist  and 
discharging  will  be  covered  as  by  a  glazing  or  coating  as  of 
collodion  after  a  ten  minutes'  exposure ;  that  the  skin  becomes 
thinned  and  atrophied  after  a  series  of  exposures,  that  a  so- 
called  dermatitis  occurs.  An  x-ray  dermatitis  is  not  analogous 
to  an  inflammatory  process  but  to  the  commencing  stage  of 
necrosis,  to  be  followed,  if  persisted  in,  by  a  type  of  necrosis 
occurring  from  no  other  source.  When  exposures  are  made 
to  an  unprotected  surface,  with  sufficient  energy  to  produce 
tissue  necrosis  a  striking  evidence  is  presented  of  the  varying 
degree  of  intensity  relative  to  the  distance  from  the  central 
point  of  exposure  over  the  convex  surface  nearest  the  source, 
and  of  greatest  intensity — the  part  closest  to  the  rays  will  be 
necrotic,  and  between  the  center  of  the  exposed  field  and  the 
margin  where  normal  skin  is  present  all  shades  of  vitality  will 
be  induced  from  without  inward.  This  fact  explains  the  tedious 
process  toward  recovery  after  one  of  these  serious  mishaps. 

"  The  effects  upon  the  various  organic  structures  of  the  body 
are  in  full  accord  with  the  first  hypothesis.  The  effects  of  the 
ray  in  leukemia  while  they  seem  to  be  beneficent,  by  diminish- 
ing the  enlargement  of  the  glandular  structures,  have  been 


OPPOSITE  EFFECTS  OF  ROENTGEN  RAY      87 

shown  from  a  long  series  of  cases  to  produce  only  temporary 
alteration  in  the  character  of  blood,  while  in  the  end,  the  patient 
dies.  It  would  seem  in  this  instance  that  the  ray  was  inter- 
fering with  a  beneficent  provision  of  nature. 

"  In  hyperidrosis  pedis  by  a  few  x-ray  exposures,  the  activity 
of  secretion  is  abated.  It  has  been  shown  by  many  observers 
that  enlarged  thyroids  may  be  reduced  in  size  by  a  series  of  ex- 
posures, but  no  evidence  of  complete  suspension  of  function  has 
been  presented.  The  effect  upon  the  absorbents,  as  is  demon- 
strated by  prolonged  exposures  over  the  abdomen,  is  to  lessen 
the  functional  activity  with  marked  decrease  of  body  weight. 
The  effect  upon  all  tissues  the  habitat  of  germ  processes  is  to 
destroy  or  diminish  the  activity  of  the  germ  by  rendering  the 
abode  unsuitable.  The  effect  upon  glandular  structures  is  to 
produce  inactivity,  as  stated  previously.  The  processes  of  ovu- 
lation,  fetal  development  and  the  function  of  the  seminal 
vesicles  may  be  seriously  impaired  or  suspended,  the  degree 
of  interference  depending  upon  the  extent  of  the  exposure. 
These  functions,  except  a  possible  termination  of  pregnancy, 
will  resume  normal  conditions  in  a  few  months  after  the  cessa- 
tion of  exposure.  In  all  cases  these  results  are  evidences  of  sus- 
pension of  nutrition  or  activity  arising  from  contraction  of  the 
cell." 

The  experiments  of  Dr.  Edward  C.  Titus,  as  published  *  fur- 
ther demonstrate  the  inhibitory  action  of  the  Roentgen  ray  upon 
germ  processes,  as  well  as  upon  the  germinal  spot  in  eggs  and 
seeds. 

"  Being  greatly  interested  in  these  investigations,  I  made  a 
series  of  experiments  to  which  I  will  now  briefly  refer. 

"  I  took  a  definite  quantity  of  various  seeds,  such  as  bird 
seed,  lentils,  peas,  beans,  and  oats,  and  planted  one  portion  of 
them  in  soil  and  another  portion  in  wet  cotton  in  order  to  deter- 
mine whether  they  would  grow. 

"  Having  convinced  myself  of  this  I  then  subjected  another 
portion  of  the  seeds  from  the  same  supply  to  the  action  of  the 
x-rays,  then  sowed  them  under  the  same  conditions,  and  now 
found  that  no  growth  took  place.  When,  however,  some  of 

*  "  Relative  Action  of  the  Roentgen  Ray  and  Light  upon  the  En- 
zymes, and  Their  Therapeutic  Significance,"  JOURNAL  OF  ADVANCED 
THERAPEUTICS,  November,  1905. 


88  RADIANT  LIGHT  AND  HEAT    . 

these  rayed  seeds  were  exposed  to  the  parallel  rays  of  a  marine 
searchlight  and  afterwards  planted,  they  began  to  sprout,  but 
not  as  vigorously  as  in  the  control  experiment.  My  next  ex- 
periment was  made  with  fresh  hen's  eggs  procured  from  a  re- 
liable dealer ;  these  were  divided  into  three  lots.  Of  these  one 
dozen  were  placed  in  an  incubator  and  after  three  weeks  nine 
were  found  to  have  been  hatched.  The  next  two  lots  of  one 
dozen  each  were  subjected  to  prolonged  exposure  to  the  x-rays 
and  of  these  one  dozen  were  placed  at  once  in  the  incubator  and 
the  remainder  first  submitted  to  the  action  of  the  searchlight 
before  doing  so.  The  two  dozen  which  had  been  rayed  were 
left  in  the  incubator  for  four  weeks,  and  when  removed  it  was 
found  that  those  which  had  not  been  exposed  to  the  light  had 
undergone  no  evolution  whatever,  while  those  which  had, 
showed  different  stages  of  embryonic  development." 

These  results,  together  with  experiments  by  the  writer  during 
the  summer  of  1904,  led  to  the  conclusion  that  from  these  two 
forms  of  radiant  energy — radiant  light  and  heat  and  the  Roent- 
gen ray — there  were  distinctly  opposite  effects ;  the  stimulating 
effects  of  the  former,  and  the  inhibitory  effects  of  the  latter, 
each  diametrically  opposed  to  the  other.  In  an  editorial  in  that 
year,  the  writer  had  called  attention  to  the  fact  as  follows: 

"  One  year's  experience  in  the  employment  of  a  thirty-five 
ampere  arc  light,  projecting  parallel  rays  from  a  parabolic  mir- 
ror, as  provided  in  a  marine  searchlight,  has  demonstrated  its 
great  value  in  preventing  x-ray  dermatitis.  Whereas,  formerly 
this  condition  appeared  in  from  three  to  five  weeks,  varying 
with  the  resistance  of  the  individual  case,  it  is  now  possible  to 
keep  up  the  x-ray  exposures  indefinitely  in  most  cases.  The 
x-ray  diminishes  the  resistance  of  the  skin,  and  light  increases 
it.  If,  therefore,  it  is  desirable  to  produce  a  profound  effect 
of  the  x-rays  upon  tissues  beneath  the  integument,  the  employ- 
ment of  the  arc  light  of  sufficient  intensity,  projected  against 
the  surface,  will  restore  the  resistance  of  the  skin,  without 
diminishing  the  effects  of  the  ray  upon  parts  beneath. 

"  It  is  customary  to  employ  an  arc  of  sufficient  intensity  to 
produce  heat  which  can  be  just  tolerated  over  a  circle  fifteen 
to  twenty  inches  in  diameter,  when  the  patient  is  placed  ten 
feet  from  the  apparatus,  i.e.,  with  parallel  rays  thrown  against 
the  surface.  The  use  of  the  arc  light  is  usually  begun  after 
exposures  to  the  x-ray  have  been  made  on  alternate  days  for 


OPPOSITE  EFFECTS  OF  ROENTGEN  RAY      89 

about  two  weeks,  and  persisted  in  during  the  course  of  treat- 
ment to  be  administered  for  ten  to  fifteen  minutes  following 
each  application.  Under  this  regime  it  is  possible  to  keep  up 
practically  continuous  application  of  the  x-ray  without  the  in- 
duction of  dermatitis ;  or,  if  dermatitis  occurs,  the  skin  may  be 
restored  to  a  normal  condition  in  the  shortest  possible  time  by 
this  method  of  treatment.  For  obvious  reasons,  the  arc  light 
is  not  employed  over  superficial  or  open  processes.  It  is  hardly 
necessary  to  add  that  whenever  a  dermatitis  does  occur,  even  as 
it  may  occasionally,  during  its  employment  combined  with  the 
light,  x-ray  exposures  should  be  discontinued,  and  the  use  of 
the  light  persisted  in. 

"  The  employment  of  the  arc  light  in  the  above  manner  adds 
to  the  possibility  of  success  in  the  treatment  of  deep-seated 
conditions.* 

It  will  be  "observed  therefore  from  the  foregoing  observations 
and  experiments  that  the  effects  of  radiant  light  and  heat  are 
diametrically  opposite  to  each  other.  In  other  words,  one  is 
the  exact  antithesis  to  the  other — the  former  producing  direct 
stimulation  and  increased  metabolism  and  nutrition,  while  the 
other,  carried  to  the  physiological  degree,  induces  distinct  in- 
hibition and  diminished  metabolism,  terminating  in  a  degree 
of  tissue  inertia  which  will  result  in  the  death  of  the  tissues 
irradiated  if  carried  too  far. 

The  high-frequency  currents,  static-brush  discharge  and 
other  stimulating  electrical  discharges,  are  analogous  in  other 
effects  to  radiant  light  and  heat,  and  offset  in  a  similar  manner 
the  inhibitive  effects  of  the  Roentgen  ray.  Failure  to  recog- 
nize this  fact  has  led  to  incorrect  observations  with  reference 
to  the  Roentgen  ray  as  applied  with  the  tube  in  contact  with 
the  tissues;  one  writer  having  misconstrued  the  fact  that  with 
the  x-rays  administered  in  this  way,  a  mixed  effect  is  derived 
from  the  high-frequency  discharges  from  the  surface  to  the 
tube  when  so  applied ;  for  which  reason  much  longer  exposures 
are  required  to  produce  the  peculiar  effects  of  the  x-ray  result- 
ing in  a  final  dermatitis.  A  dermatitis  will  occur,  however, 
from  x-rays  applied  in  this  manner,  as  has  been  demonstrated 
in  the  experience  of  several  observers,  indicating  that  the 

*  "  The  Employment  of  the  Arc  Light  as  a  Prevention  to  X-ray 
Dermatitis  in  the  Treatment  of  Deep-seated  Conditions,"  JOURNAL  OF 
ADVANCED  THERAPEUTICS,  December,  1904. 


90  RADIANT  LIGHT  AND  HEAT 

Roentgen  ray  administered  for  the  same  length  of  time  with 
the  mixed  high-frequency  discharges,  has  a  dominant  effect. 
From  this  fact  it  will  be  generally  acknowledged  that  it  is  bet- 
ter to  employ  an  agent  strong  enough  to  induce  an  inhibition 
first,  and  when  signs  of  dermatitis  appear,  to  then  institute 
the  use  of  light  or  the  high-frequency  currents  to  offset  or 
restore  a  degree  of  tone  to  the  tissues,  which  will  prevent  an 
unpleasant  degree  of  x-ray  dermatitis.  The  writer  has  used  the 
x-ray  and  the  other  forms  of  radiant  energy  in  this  manner  and 
has  demonstrated  all  these  relative  effects  for  the  past  five  years. 
Without  exception,  the  dermatitis  produced  by  the  Roentgen 
ray  has  been  readily  counteracted  by  the  subsequent  applica- 
tion of  radiant  light,  or  the  static  brush-discharge  or  the  high- 
frequency  currents  to  a  surface  so  affected. 


SECTION  II 

CONVECTIVE    HEAT 


CHAPTER  I 

COMPARISON  OF  CONVECTIVE  HEAT  AND  RADI- 
ANT HEAT 

Connective  heat,  in  contradistinction  to  radiant  heat,  pos- 
sesses the  advantage  of  being  a  convenient  means  for  domes- 
tic and  professional  administration  under  conditions  in  which 
the  combined  heat  and  light  radiations  from  the  sun,  or  the 
electrical  incandescent  or  arc  light,  are  not  accessible  nor  con- 
venient, and  may  be  preferred  in  certain  cases.  The  physical 
difference  between  these  two  methods  of  heat  administration 
for  therapeutic  purposes  is  at  once  suggested  by  the  distinc- 
tion between  radiation  and  convection. 

Radiant  energy  projected  against  the  tissues,  penetrates  to 
considerable  depth  as  the  radiant  heat  energy  moving  with 
great  rapidity  impinges  upon  the  tissues  of  the  body.  Ad- 
ministered from  radiant  sources,  the  action  is  not  to  the  same 
extent  limited  to  the  circulating  fluids  of  the  body,  but  acts 
upon  all  other  structures  upon  which  the  radiations  impinge 
and  to  a  greater  depth;  including  all  cells  of  the  muscular, 
nervous,  and  connective  tissue  structures;  thereby  carrying 
into  the  tissues  degrees  of  heat,  which  are  not  rapidly  dis- 
persed by  convection,  and  raising  and  maintaining  the 
temperature  of  the  tissues  to  a  higher  degree  than  with  the 
convective  methods  of  administration;  the  influence  of  which, 
applied  to  the  surface  of  the  body,  does  not  permit  the  penetra- 
tion of  the  heat  to  any  considerable  depth  as  has  been  well 
shown  by  Oilman  Thompson  and  others.  By  the  convective 
methods,  the  blood  becoming  heated  is  rapidly  conveyed  on- 
ward, raising  the  temperature  of  the  body,  but  resulting  under 
normal  conditions,  in  the  induction  of  intense  hyperemia  and 
perspiration,  followed  by  evaporation  with  the  secondary 
cooling  effect  of  latent  heat  absorption,  thereby  maintaining 
normal  blood  temperature  throughout  the  body.  Another  ad- 
vantage is  also  conserved — the  elimination  of  effete  material 
through  the  activity  of  the  sweat  glands.  The  areas  imme- 
diately contiguous  to  the  application  of  convective  heat,  be- 
come at  first  hyperemic  through  the  stimulating  effect  of 
the  application,  thereby  permitting  a  larger  volume  of  the  blood 

93 


94  CONVECTIVE  HEAT 

stream  to  become  heated  and  coincidently  other  actions  take 
place  within  the  tissues  in  the  vicinity,  the  importance  of  which 
will  be  subsequently  considered. 

In  the  application  of  convective  heat,  moist  and  dry,  the  fol- 
lowing methods  are  employed : 

The  application  of  dry  heat  to  the  surface  of  the  body  may 
be  made  with  temperatures  ranging  from  150°  to  200°  F., 
tolerated  without  covering.  It  is  readily  apparent  that  dry 
heat  possesses  certain  distinct  advantages  in  cases  demanding 
a  marked  degree  of  general  peripheral  stimulation,  and  coin- 
cidently in  a  dry  air  a  rapid  absorption  of  heat  by  the  prompt 
evaporation  of  perspiration  takes  place,  thereby  facilitating 
profuse  elimination  of  effete  and  toxic  materials  and  inducing 
a  marked  degree  of  end  nerve  stimulation  followed  by  prompt 
responses  of  the  vascular  and  respiratory  centers.  Moist  heat 
applications  do  not  permit  of  local  evaporation,  though  the 
heating  of  the  blood  does  induce  perspiration  to  a  degree  from 
the  surface  of  the  body  not  exposed  to  the  direct  application 
of  the  moist  heat.  These  distinctions  render  the  two  forms 
of  convective  heat  application  of  distinct  advantage  or  dis- 
advantage according  to  the  condition  for  which  it  is  employed. 

The  means  of  applying  moist  heat  have  been  long  in  vogue 
and  comprise  the  employment  of  poultices,  a  combination  of 
kaolin  and  glycerine,  or  the  familiar  antiphlogistine  adminis- 
trations, as  well  as  the  use  of  douches,  and  the  general  ap- 
plication of  steam  or  Russian  baths.  Moist  applications  may 
also  be  applied  by  placing  a  damp  flannel  cloth  over  the  surface 
treated,  over  which  dry  heat  should  be  applied  from  hot  flannel 
pads,  hot  water  bags,  or  other  heated  material. 

The  method  of  using  moist  heat  may  be  by  application  of 
local  poultices,  hot  water  bags,  pads  or  other  heated  mate- 
rials placed  over  moistened  flannels,  or  the  employment  of 
kaolin  cataplasms,  or  antiphlogistine,  heated  as  hot  as  can  be 
borne,  the  heat  being  maintained  in  all  cases  by  frequent 
changes  of  the  poultice  or  overlying  material  which  gives  up 
its  heat  least  rapidly,  as  water  in  bags,  or  heated  flannels,  or 
heated  objects  wrapped  in  flannel.  Another  well  recognized 
method  of  applying  heat  to  the  cavities  of  the  body  is  by  means 
of  hot  water  douches  or  enemas.  For  general  applications  of 
moist  heat,  the  hot  bath  or  Turkish  or  steam  baths  are  the 
means  usually  employed. 


CHAPTER  II 
PHYSIOLOGICAL  EFFECTS  OF  CONVECTIVE  HEAT 

The  physiological  effects  of  convective  heat  give  it  rank 
among  the  most  valuable  of  the  therapeutic  agents.  It  occu- 
pies a  well  recognized  place  of  great  utility  in  the  sanitariums, 
at  the  bedside,  and  in  the  office  of  the  practitioner.  The  effects 
may  be  divided  into  local  and  general. 

The  local  applications  of  convective  heat  as  applied  to  in- 
flammatory conditions,  from  the  point  of  view  of  a  local  con- 
stringent, was  ably  described  by  Dr.  Thomas  Addis  Emmett  in 
the  third  edition  of  his  work  on  "Principles  and  Practice  of 
Gynecology,"  page  HI,  in  the  following  language: 

"Cold  is  a  prompt  exciter  of  reflex  action  by  which  the  ves- 
sels are  made  to  contract,  but  on  reaction  taking  place,  the 
parts  will  become  more  congested  than  before,  both  the  arteries 
and  the  veins  being  distended. 

"Heat,  unless  at  a  temperature  that  would  destroy  the  parts, 
does  not  act  so  promptly  in  causing  this  contraction  as  either 
electricity  or  cold.  In  fact,  its  immediate  effect  is  to  cause 
relaxation,  and  to  increase  the  congestion  of  the  parts;  but, 
if  its  application  is  prolonged  reaction  ensues,  and  contraction 
takes  place;  in  other  words,  the  reaction  from  heat  is  con- 
traction. Under  the  increased  nerve  stimulus  the  capillaries 
are  excited  to  contract,  this  effect  extending  also  to  the  coats 
of  the  larger  vessels,  and  as  their  caliber  becomes  smaller  the 
congestion  is  diminished.  The  popular  belief  is  that  heat 
relaxes  and  increases  the  congestion  of  parts,  and  such  indeed 
is  the  case  at  first.  But  a  hot  poultice  is  never  applied  with 
the  object  of  increasing  the  congestion,  but,  as  any  'old  wife' 
would  express  it,  to  draw  the  'fire'  or  inflammation  out;  in 
other  words,  it  lessens  the  congestion  by  stimulating  the  blood- 
vessels to  contract.  That  such  is  the  effect,  from  the  pro- 
longed use  of  a  poultice,  is  familiar  to  everyone,  and  is  well 
shown  by  the  blanched  and  shriveled  appearance  of  the  tissues 
after  its  removal.  The  hands  and  arms  of  a  washerwoman, 
when  in  hot  water,  become  swollen  at  first,  from  the  increased 

95 


96  CONVECTIVE  HEAT 

flow  of  blood  to  them,  but  it  is  a  well-known  fact  that  they 
afterwards  become  markedly  shriveled. 

"Placing  the  hands  in  cold  water  at  once  causes  the  skin 
to  shrivel,  as  the  vessels  are  stimulated  to  contract,  but  we 
know  that  reaction  promptly  comes  on,  and  a  larger  quantity 
of  blood  returns  to  the  parts  than  was  driven  out.  But,  after 
soaking  in  hot  water,  the  skin  does  not  recover  its  natural  ap- 
pearance for  hours,  since  the  capillaries  remain  contracted.  In 
their  return  to  the  natural  state  the  reaction  does  not  go  on 
to  a  paralysis  of  over-distention,  and  hence  there  is  no  sub- 
sequent congestion.  The  immediate  effect  of  cold  upon  the 
capillaries,  therefore,  is  contraction,  and  with  reaction  comes 
dilatation ;  but  the  reverse  is  true  of  heat,  which  causes  at  first 
dilatation,  followed  by  contraction." 

Acting  upon  the  principles  laid  down  in  the  above  explana- 
tion of  the  effects  of  heat  and  cold,  the  author  has  made  use 
of  these  agents  for  more  than  twenty  years.  At  the  time 
of  the  publication  of  the  third  edition  of  Dr.  Emmett's  work 
(1884),  there  was  no  published  knowledge  of  the  action  of 
the  phagocytes — connective  tissue  cells  (macrophages),  or 
leucocytes  (microphages) — which  envelop  germs  and  devour 
them.  The  significance,  therefore,  of  the  induction  of  intense 
local  hyperemia  and  the  fact  that  such  hyperemia  favored  de- 
struction of  microbes,  could  not  then  be  appreciated.  At  this 
time,  however,  when  it  is  a  well  established  fact  that  the  body 
in  varying  degrees  depending  upon  the  physical  condition  of 
the  individual  is  capable  by  its  own  defenses  of  destroying  in- 
fectious elements  through  the  agency  of  these  active  cell 
bodies,  the  recognition  of  phagocytosis  is  of  the  greatest  sig- 
nificance. 

That  in  the  early  stage  of  superficial  suppurating  processes, 
the  application  of  heat,  with  the  proper  degree  of  energy,  is  a 
most  certain  means  of  resolving  the  process,  has  been  estab- 
lished by  the  writer  and  many  other  observers  by  practical 
experience. 

There  are  several  possible  factors  which  may  be  active  in 
effecting  the  resolution  and  healing  of  septic  processes  as  in- 
duced by  the  administration  of  hot  applications,  (i)  The 
increased  hyperemia  occurring  with  tissue  relaxation,  which 
is  present  during  the  early  part  of  the  heat  administration, 
brings  into  the  involved  tissues  a  greater  number  of  leucocytes 


EFFECTS  OF  CONVECTIVE  HEAT  97 

in  proportion  as  the  volume  of  arterial  blood  is  increased,  to- 
gether with  an  increased  amount  of  oxygen,  so  essential  to 
local  metabolism  and  prompt  diapedesis  of  the  leucocytes. 
(2)  The  profuse  local  and  general  perspiration  induced,  alters 
toward  normal  the  fluids  in  the  field  of  involvement  and  coin- 
cidently  eliminates  to  an  extent  other  materials  affecting  the 
constitutional  condition  of  the  patient  possibly  favoring  a 
general  phagocytosis.  (3)  The  action  of  heat,  upon  the  super- 
ficial tissues,  may  coincidently  inhibit  the  activity  of  the  mi- 
crobes, or  by  altering  the  constitution  of  the  fluids,  as  sug- 
gested, produce  a  larger  degree  of  positive  chemotaxis.  (4) 
The  production  of  more  active  metabolism  in  the  tissues  will 
tend  also  to  increase  the  natural  fortifications  of  the  involved 
tissues,  increasing  the  activity  of  the  macrophages. 

Clinical  experience  has  well  demonstrated  the  efficacy  of 
the  hyperemia  and  stimulating  effects  of  heat  in  effecting  the 
local  destruction  of  infection — a  fact  worthy  of  investigation 
and  definite  determination  as  to  whether  in  the  workings  of  the 
vis  medicatrix  natures  the  fever  process  is  not  a  condition 
created  for  action  unfavorable  to  the  infecting  microbes,  by 
coincidently  favoring  a  positive' chemotaxis  or  action  tending 
tq_  limit  the  disease.  The  remarkable  effects  derived  from  ad- 
ministrations of  dry  hot  air  in  the  destruction  of  local  and 
general  infection  with  the  coincident  falling  of  the  body  tem- 
perature to  normal,  would  seem  to  indicate  that  the  workings 
of  nature's  processes  against  infection  are  normally,  by  rais- 
ing the  body  temperature  to  assist  the  phagocytes,  to  destroy 
the  microbes  by  the  induction  of  such  increased  body  tempera- 
ture— the  fever.  If  so,  it  is  evidently  an  error,  except  under 
conditions  of  extreme  hyperpyrexia,  to  interfere  with  body 
temperature,  and  rather  than  employ  cold  baths,  to  institute  the 
use  of  the  body  dry  hot  air  or  light  baths  to  assist  nature,  in 
increasing  the  activity  of  the  phagocytes. 

The  following  observations  made  by  the  writer,  with  Drs. 
Grad  and  Munday,  would  seem  to  fortify  this  hypothesis.  A 
patient  in  extremis  from  general  septicemia,  three  weeks  after 
a  difficult  surgical  operation,  with  the  characteristic  feeble 
pulse,  livid  countenance,  and  a  temperature  of  105°  F.,  was 
wrapped  by  the  usual  method  in  Turkish  toweling  and  placed 
in  a  body  hot  air  apparatus  at  a  temperature  of  300°  to  350° 
F.,  and  after  thirty  minutes  removed  with  a  full  strong  pulse, 


98  CONVECTIVE  HEAT 

a  marked  hyperemia  of  the  skin,  and  a  mouth  temperature  of 
103°  F.  Eight  hours  later  the  temperature  was  normal,  and 
the  patient  convalescent  in  ten  days.  This  extraordinary  re- 
sult could  only  be  explained  by  (i)  the  induction  of  an  active 
phagocytosis  with  a  positive  chemotaxis;  (2)  stimulation  by 
heat  of  the  deep  spinal  centers,  particularly  the  cardiac  and 
respiratory;  and  (3)  the  elimination  of  toxins  and  other 
bodies  through  the  agency  of  the  profuse  perspiration  induced 
by  the  high  temperature. 

The  writer  has  invariably  observed  the  rapid  fall  of  tem- 
perature following  the  application  of  heat  to  areas  of  local 
infection  as  in  suppurative  tonsilitis,  as  well,  also,  in  cases  in 
which  the  static  current  has  been  employed  for  the  relief  of 
early  local  infection. 

The  action  of  local  dry  heat  on  localized  septic  infection, 
when  high  temperatures  are  employed,  as  in  the  case  above 
described,  has  been  uniformly  successful  in  the  writer's  ex- 
perience even  in  cases  of  extensive  local  infection  involving 
the  hand  and  arm  and  also  in  cases  of  gangrene,  all  tending 
to  confirm  the  physiological  effect  of  high  temperature  in  re- 
lieving local  as  well  as  general  infection. 

In  conditions  of  poor  metabolism,  arising  from  bodily  in- 
activity, excesses  in  diet,  and  auto-intoxication,  the  effects  of 
convective  dry  heat  or  the  combination  of  radiant  light  and 
heat  together  with  convective  heat,  as  administered  in  in- 
closures  with  the  high  candle-power  incandescent  or  arc  lights, 
or  better  in  the  incandescent  electric  light  bath,  are  remarkably 
efficient  in  promoting  the  elimination  of  waste  products  through 
the  skin,  and  coincidently  by  stimulation  of  the  deep  spinal 
centers,  the  effect  of  exposure  of  the  surface  to  intense  heat 
thereby  inducing  greater  activity  of  the  other  channels  of  ex- 
cretion and  elimination.  This  fact  is  clinically  well  demon- 
strated by  chemical  analysis  of  the  secretions  and  relief  from 
conditions  of  auto-intoxication,  nephritis,  and  gouty  and  rheu- 
matic affections.  It  is  an  undoubted  fact  that  owing  to  effects 
of  profuse  perspiration,  the  sweat  glands  do  eliminate  nitrog- 
enous, toxic,  and  other  effete  materials  from  the  organism, 
which  in  nephritis  is  wonderfully  effective  in  relieving  the  labor 
of  the  diseased  kidneys,  and  removing  the  danger  from  other 
grave  conditions. 

The  action  of  dry  heat  in  the  body  apparatus  upon  the 


EFFECTS  OF  CONVECTIVE  HEAT  99 

7r  r~ 
periphery  induces  a  pronounced  general  hyperemia  of  the  skin, 

and  coincidently  stimulates  the  activity  of  the  heart  and  rep 
spiratory  centers.  Together,  however,  with  the  profuse  per- 
spiration, the  draft  upon  the  general  circulation  to  tlu3 
hyperemia  of  the  skin,  offers  the  only  danger  from  the  a3- 
ministration  by  leaving  too  small  amount  of  blood  in  the  larger 
arteries.  Such  danger  is  obviated  by  keeping  the  patient  in 
a  recumbent  position  and  administering  frequent  draughts 
of  water  during  and  following  the  administration. 


"I  c 

~L  ^ 

111  — 
^  o 

11  1*1  ^ 

W     o     — 

ix   p-    cc 

CHAPTER  III 


ADMINISTRATION  OF  DRY  AND  MOIST  HEAT 


administrations  of  dry  heat  are  best  executed  locally 
by'me&ns  of  the  hot  water  bag  wrapped  in  dry  flannel  cloths 
to  prevent  the  too  rapid  escape  of  heat,  or  by  means  of  the 
various  dry  hot  air  apparatus  manufactured  for  local  and  gen- 
eral treatment,  by  the  application  of  other  heated  substances  to 
the  surface,  or  by  the  use  of  Turkish  baths.  The  application* 
of  dry  hot  air  by  means  of  the  hot  air  apparatus,  the  body  be- 
ing wrapped  in  Turkish  toweling,  partakes  to  a  slight  degree 
of  the  character  of  moist  applications,  the  perspiration  con- 
stantly escaping  from  the  body  to  be  absorbed  by  the  Turkish 
toweling,  but  to  no  extent  approaching  the  degree  of  moisture 
of  the  wet  applications. 

The  methods  of  applying  moist  heat  are  in  principle  the 
same;  the  object  being  to  maintain  a  temperature  as  high  as 
can  be  borne  on  the  surface  of  the  body  or  in  the  cavities  for 
periods  of  time,  varying  with  the  indication  for  relief  of  the 
affection  under  treatment. 

The  poultice,  the  oldest  popular  form  of  heat  application, 
derives  its  efficacy  from  the  length  of  time  which  it  will  main- 
tain a  higher  temperature  than  the  body.  The  material  best 
suited  for  the  purpose  is  therefore  one  which  will  hold  the 
heat  for  the  longest  time.  Flax-seed  has  generally  been  the 
material  preferred.  The  writer  recalls  the  old  way  in  which 
the  poultice  was  used  by  the  layman  and  the  physician  who 
little  appreciated  the  requirements  of  the  poultice.  A  thin  paste 
applied  hot,  as  if  the  virtue  lay  in  the  paste,  but  not  changed 
for  hours,  or  a  day,  was  too  often  the  error  of  our  ancestors 
and  their  patients.  By  these  it  was  little  realized  that  the 
object  of  the  poultice  was  the  application  and  maintenance  of 
intense  heat  for  its  therapeutic  properties. 

Time  has  practically  displaced  the  poultice  as  the  institu- 
tion of  the  hot  water  bags  and  the  later  preparations  of  kaolin 
cataplasms  of  which  the  proprietary  preparation,  antiphlogis- 
tine,  was  the  earliest  if  not  the  best  product  of  the  kind.  It 


ADMINISTRATION  OF  DRY  AND  MOIST  HEAT    101 

possesses  such  advantages  over  the  sodden  poultice  that  the 
latter  is  employed  relatively  little  by  the  present  generation. 
In  his  own  private  practice  the  writer,  before  the  days  of 
antiphlogistine  and  before  the  general  use  of  the  water  bag, 
recognizing  the  principles  of  heat  application,  instituted  for 
his  own  cases  the  employment  of  large,  thick,  woolen  pads, 
made  of  old  material  quilted  together  in  pads  of  one  and  one- 
half  to  two  inches  in  thickness,  and  of  sizes  large  and  small 
to  meet  varying  conditions,  two  of  them  being  always  in  requi- 
sition. It  was  the  custom  to  apply  the  heat  in  this  manner 
by  placing  one  thickness  of  flannel  cloth  wrung  from  hot  water 
over  the  inflamed  area,  following,  usually,  the  application  of 
a  sinapism,  alternating  the  application  of  these  two  pads  every 
fifteen  or  twenty  minutes,  thereby  maintaining  for  hours  an 
intense  application  of  moist  heat,  the  changes  being  effected 
without  exposing  the  surface  to  the  cool  air  of  the  room. 

The  hot  water  bag  may  be  employed  in  the  same  manner, 
but  its  weight  is  often  objectionable.  When  used,  if  wrapped 
in  flannel,  the  heat  is  preserved  for  a  longer  time.  When  of 
the  proper  size,  if  the  water  is  frequently  changed,  it  is  a  con- 
venient and  practical  means  of  maintaining  heat  application. 

In  antiphlogistine,  the  proprietary  preparation,  or  the 
kaolin  cataplasm,  is  added  the  hygroscopic  glycerine  which  is 
capable  of  abstracting  considerable  fluid  from  the  tissues — 
another  advantage  particularly  in  inflammatory  conditions  as- 
sociated with  infiltration.  When  this  or  similar  preparations 
are  used  they  should  be  applied  in  a  thick  coating  and  as  hot 
as  can  be  borne  directly  to  the  bare  skin.  It  is  desirable  in 
most  cases  to  maintain  the  heat  in  these  materials  by  the  appli- 
cation of  dry  heat  over  all,  as  of  the  hot  water  bag,  the  addi- 
tional application  thereby  maintaining  the  heat  as  long  as  is 
desirable.  In  these  applications  the  effect  is  derived  from  the 
dry  heat  and  the  combined  depleting  effects  of  the  glycerine 
in  combination  with  the  heat  conducting  qualities  of  the 
material  of  which  they  are  composed. 

The  Russian  bath  is  deservedly  the  least  popular  of  all  of 
the  moist  applications ;  because  the  patient  is  not  only  subjected 
to  intense  heat  in  a  moist  atmosphere,  and  the  necessity  of 
employing  lower  temperatures  because  the  moisture  does  not 
permit  of  ready  evaporation  from  the  surface  of  the  body  of 
perspiration,  and  at  the  same  time  the  patient  is  subjected  to 


102  CONVECTIVE  HEAT 

the  inhalation  of  the  heated  steam.  The  method  is  of  too  little 
therapeutic  value  to  deserve  more  than  mention  of  its  char- 
acteristics. Administrations  of  convective  dry  heat  in  a  hot 
box  or  the  Turkish  bath  in  such  a  manner  that  the  perspiration 
will  be  rapidly  evaporated,  are  far  superior  in  their  effects  to 
the  use  of  the  moist  steam  bath. 

The  hot  water  bath  as  a  general  application  possesses  an 
advantage  over  the  Russian  bath  and  is  a  convenient  method 
of  inducing  prompt  relaxation  or  reflex  stimulation  under  con- 
ditions in  which  it  would  not  be  convenient  to  administer  the 
Turkish  or  dry  hot  air  bath. 

The  hot  douche  for  the  employment  of  heat  by  means  of  hot 
water,  is  the  recognized  method  of  administering  heat  to  the 
cavities  of  the  body.  The  method  was  first  accorded  urgent 
recommendation  by  Dr.  Thomas  Addis  Emmett,  of  New  York. 
The  value  of  this  measure  is  appreciated  by  the  profession  at 
large;  but  too  often  douches  have  been  administered  in  a 
perfunctory  manner,  the  necessity  for  maintaining  the  tempera- 
ture at  108°  to  110°  F.  for  long  enough  periods  of  time  not 
having  been  generally  appreciated  by  many  who  have  employed 
and  prescribed  it.  The  value  of  this  method  was  ably  described 
in  the  work  of  Dr.  Emmett. 

The  administration  of  dry  heat  may  be  made  either  by  means 
of  apparatus  constructed  for  the  purpose  as  the  local  and 
body  hot  air  apparatus,  or  by  means  of  light  baths  which  com- 
bine the  effects  of  radiant  and  convective  heat ;  the  accumulated 
heat  in  the  inclosed  cabinet  having  the  convective  characteristic 
with  the  radiant  heat  added. 

Another  method  which  is  practical  at  the  bedside  is  effected 
by  placing  alongside  of  the  patient,  covered  with  one  thickness 
of  Turkish  toweling  to  prevent  the  bottles  of  hot  water  from 
coming  in  contact  with  the  skin,  or  by  wrapping  the  receptacles 
in  moist  or  dry  flannel  cloths,  as  many  gallons  of  boiling  hot 
water  as  is  desirable,  covering  all  with  flannel  blankets.  In  this 
manner  dry  heat  may  be  applied  with  pronounced  effect  at  a 
temperature  of  approximately  200°  F.  and  maintained  for  as 
long  a  time  as  desirable. 

When  the  local  or  body  hot  air  apparatus  is  employed,  the 
parts  exposed  to  the  heat  should  be  wrapped  in  two  or  three 
layers  of  Turkish  toweling  so  applied  as  to  come  in  contact 
with  every  part  of  the  surface  so  exposed,  in  order  that  the 


Plate  VII. — Local   Betz   Knee  Joint  Apparatus  as  Applied. 


ADMINISTRATION  OF  DRY  AND  MOIST  HEAT    103 

perspiration  as  it  escapes  from  the  tissues  may  be  taken  up 
by  capillary  attraction  from  the  surface  by  the  little  wicks 
of  the  toweling.  At  any  part  of  the  surface  that  is  not  in  con- 
tact, drops  of  water  will  collect,  boil,  and  scald  the  surface; 
for  with  the  temperatures  employed,  300°  to  400°  F.,  the  water 
will  be  readily  raised  to  212°  by  the  penetration  of  heat  through 
the  wrappings.  The  rapid  evaporation  from  the  skin  under 
these  conditions  permits  an  intense  application  of  heat  to  the 
surface  under  the  above  precautions,  with  the  induction  of 
intense  hyperemia  and  without  danger  to  the  tissue  so  exposed, 
offering  one  of  the  best  facilities  for  the  induction  of  pro- 
found reflex  stimulation  and  intense  hyperemia  so  valuable  for 
the  treatment  of  infectious  troubles,  as  well  as  inducing  pro- 
nounced elimination  through  the  agency  of  the  perspiration. 

The  hot  box,  used  in  connection  with  hydrotherapeutic  ap- 
plications, is  so  constructed  that  the  patient,  seated  upon  a 
stool,  nude,  with  the  head  protruding  through  an  opening, 
which  closes  about  the  neck,  is  exposed  to  an  influx  of  dry 
heat  at  temperatures  from  200°  to  225°  F.  This  method  is  so 
employed,  when  it  is  intended  to  be  followed  by  the  applica- 
tion of  the  hydrotherapeutic  douche,  spray,  or  plunge,  the  sud- 
den changes  of  temperature  being  employed  to  induce  extreme 
degrees  of  reaction.  The  light  bath,  as  employed  by  Winternitz 
and  his  followers  in  connection  with  the  hydrotherapeutic  es- 
tablishments, is  rapidly  replacing  the  hot  box. 

The  Turkish  bath  administered  to  the  patient  nude  in  a 
room  heated  to  a  temperature  of  from  150°  to  170°  F.,  is  a  pop- 
ular method  of  applying  heat  for  the  induction  of  perspiration. 
The  particular  objections  to  this  method  are  that  the  patient  is 
obliged  to  inhale  this  heated  air,  and  that  with  the  head  in 
the  same  temperature,  moist  towels  but  partially  relieve  the  dis- 
agreeable effects  of  cerebral  congestion.  This  method  of  treat- 
ment is  as  a  rule  employed  in  connection  with  rubbing,  knead- 
ing, and  massage,  and  possesses  certain  advantages  of  a  pop- 
ular sort,  but  is  not  calculated  for  use  in  the  treatment  of 
localized  conditions,  or  when  there  is  indication  for  profound 
effects  upon  general  metabolism. 


CHAPTER  IV 
THERAPEUTICS  OF  CONVECTIVE  HEAT 

The  indications  for  the  employment  of  convective  heat  sug- 
gested by  the  physiological  effects  upon  the  organism,  com- 
prise its  application  alone  or  in  conjunction  with  radiant  light 
and  heat,  the  x-ray,  or  the  static  or  high  frequency  currents, 
one  or  more  of  them,  in  the  treatment  of  infectious  inflamma- 
tion, and  in  the  early  stage  of  traumatic  or  non-infected  inflam- 
mation, when  sometimes  better  means  are  not  at  hand.  It  is  also 
a  valuable  factor  in  association  with  other  measures  applied 
with  the  body  hot  air  apparatus  or  light  bath  for  the  relief  of 
defective  metabolism. 

The  therapeutics  of  convective  moist  and  dry  heat  at  the 
bedside  and  in  many  conditions  in  which  other  measures  bet- 
ter adapted  are  not  at  hand,  is  very  large  and  under  these 
conditions  is  one  of  the  most  valuable  means  at  command. 

The  local  use  of  convective  heat  is  indicated  in  all  super- 
ficial inflammatory  processes  associated  with  the  presence  of 
pus;  not  in  a  perfunctory  way  by  the  casual  application  of  a 
hot  wet  poultice,  a  hot  water  bag,  or  a  thick  layer  of  antiphlo- 
gistine  to  be  left  in  situ  for  hours  without  the  application  of 
additional  heat,  but  with  strict  observance  of  the  temperatures 
employed  and  of  the  time  necessary  to  meet  the  indication. 

The  treatment  of  an  early  quinsy  or  suppurative  tonsilitis 
which  may  be  readily  aborted  if  given  proper  attention,  would 
go  on  suppurating  with  the  indifferent  use  of  local  heat  appli- 
cations. In  tonsilitis  some  application  may  be  made  first  as  a 
sinapism  for  the  purpose  of  inducing  a  very  active  local  hyper- 
emia,  over  and  around  the  indurated  area,  to  be  removed  be- 
fore blistering  as  soon  as  an  intense  redness  is  effected.  A 
thin  flannel  cloth,  large  enough  to  cover  the  spot  rendered 
hyperemic  by  the  mustard,  wrung  from  hot  water  should  be 
laid  over  the  surface,  and  over  this  a  large  hot  water 
bag  covered  with  several  thicknesses  of  flannel  or  a  pad 
made  of  several  thicknesses  of  flannel  should  be  placed. 
The  hot  water  bag  or  heated  flannel  pads  used  should  be 
changed  as  often  as  necessary  to  keep  the  heat  at  as  high  and 

104 


THERAPEUTICS  OF  CONVECTIVE  HEAT      105 

uniform  temperature  as  can  be  borne.  These  applications 
should  be  maintained  for  four  or  five  hours,  or  until  every  bit 
of  induration  or  pain  has  disappeared.  If  such  applications 
are  made  on  the  first  or  second  day,  the  effect  is  abortive 
and,  as  suggested  above,  is  explained  by  the  fact  that  the 
hyperemia  is  effected  with  coincident  relaxation  of  the  involved 
tissues,  associated  with  the  presence  of  a  greater  number  and 
greater  activity  of  the  phagocytes — conditions  favorable  to  the 
destruction  of  the  germs,  followed  by  the  later  constringent 
effect  with  final  resolution  of  the  induration,  and  removal  of 
every  trace  of  the  inflammatory  process. 

The  same  effect  as  in  tonsilitis  is  readily  obtained  in  the 
treatment  of  felons  or  whitlows,  by  another  method.  With  a 
cup  of  water  and  a  pitcher  of  boiling  water  at  hand,  the  pa- 
tient is  directed  to  at  first  place  his  finger,  out  and  in,  the  fluid 
in  the  cup  until  it  can  be  held  constantly  within  the  hot  water, 
adding  from  the  pitcher  of  boiling  water  from  time  to  time 
sufficient  to  maintain  the  highest  possible  temperature  that  can 
be  borne.  It  is  important  to  keep  this  up  from  three  to  four 
hours,  or  until  all  pain  has  ceased,  and  the  finger  is  in  a 
shriveled  and  puckered  condition,  repeating  the  procedure 
after  several  hours,  if  necessary,  until  no  pain  returns.  In 
the  early  stage  when  the  throbbing  and  pain  are  well  estab- 
lished, but  before  much  pus  is  present,  this  method  will  in- 
variably abort  this  painful  condition.  The  same  result  can 
be  effected  with  the  static  brush  discharge  or  the  vacuum  tube 
current  taken  directly  from  the  static  machine  in  from  ten 
to  fifteen  minutes,  and  likewise  in  tonsilitis.  (See  Snow's 
"  High  Potential  Currents.") 

In  the  early  stage  of  mastoiditis,  or  of  furuncles  in  the 
aural  canal,  or  otitis  media,  the  surface  application  of  heat  in 
the  same  manner  as  in  the  treatment  of  tonsilitis  and  for  as 
long  or  longer  periods  of  time,  when  employed  early,  is  very 
effective  in  relieving  the  conditions,  though  not  with  such 
energy  and  promptness  as  the  application  of  radiant  heat.  The 
same  method  is  applicable  to  the  treatment  of  boils,  furuncles, 
and  other  abscesses  superficially  located. 

In  inflammatory  conditions  of  the  pleural  and  abdominal 
cavities,  applications  of  heat  on  the  same  principle  are  very 
effective,  though  in  deep-seated  conditions  they  will  often  ut- 
terly fail  of  effecting  the  desired  result. 


106  CONVECTIVE  HEAT 

In  pleurisy,  treatment  for  from  three  to  five  hours  with 
large  surface  applications  kept  as  hot  as  can  be  borne,  a  happy 
result  is  promptly  effected  in  most  cases,  and  it  is  a  question 
if  many  cases  of  pneumonia  may  not  be  aborted  by  these  same 
early  applications  of  heat  in  conjunction  with  other  rational 
procedures.  Probably  in  this  case  the  employment  of  kaolin 
cataplasms  or  antiphlogistine  in  a  thick  hot  layer  placed  over 
the  affected  area,  over  which  applications  of  heat  are  made  to 
maintain  the  temperature,  is  a  most  convenient  and  effective 
means  of  treatment.  It  is  a  striking  fact  that  over  some  condi- 
tions, these  preparations,  mixed  as  they  are  with  glycerine,  will 
become  dry  and  hardened,  while  in  others  the  abstraction  of 
moisture  will  cause  the  composition  to  become  thin  and  volatile 
in  consistence.  This  is  explained  from  the  fact  that  in  severe 
inflammatory  conditions  of  congestion  with  impaired  secretion, 
the  tissues  seem  to  absorb  the  glycerine  from  the  compound. 

In  peritonitis  and  the  painful  conditions  associated  with 
appendicitis  or  other  abdominal  abscesses,  where  the  weight 
of  the  application  is  an  objectionable  feature,  the  application 
of  a  sinapism,  followed  by  the  flannel  cloth  wrung  from  hot 
water,  and  the  subsequent  frequent  changing  of  heated  flannel 
pads,  for  hours,  maintaining  as  high  a  temperature  as  can 
be  tolerated,  is  indicated.  This  method  first  favors  a  localized 
active  phagocytosis,  and  is  later  followed  by  a  resolvent  action 
and  restoration  in  favorable  cases  as  a  result  of  the  destruction 
of  the  germ  in  situ. 

Applied  for  relief  of  the  deeper  processes,  as  demonstrated 
by  Oilman  Thompson,*  the  effects  of  convective  heat  are  not 
effective.  Hence  the  administration  of  convective  dry  heat 
is  generally  ineffective,  except  in  so  far  as  it  raises  the 
general  resistance  by  promoting  metabolism  and  general  elim- 
ination. In  such  cases,  however,  the  body  hot  air  bath,  by  em- 
ploying very  high  temperatures,  offers  much ;  but  probably  no 
agent,  except  the  x-ray,  which  has  a  potent  effect  upon  pus 
processes,  is  more  efficacious  in  deep-seated  processes  than 
radiant  light  and  heat  focused  to  small  surfaces  or  applied 
largely  from  sources  of  high  candle-power.  There  is  no  doubt 
in  the  mind  of  the  writer,  from  his  own  experience,  and  the 
experience  of  his  confreres,  that  radiant  light  and  heat  are  very 
effective  in  influencing  deep  inflammatory  processes  in  the 

*  Thermotherapy,  New  York  Medical  Record,  April,  1907. 


THERAPEUTICS  OF  CONVECTIVE  HEAT      107 

cavities  of  the  trunk,  and  are  indicated  in  all  such  cases,  the 
applications  being  made  for  considerable  time,  and  as  close  to 
the  source  of  radiation  as  can  be  borne,  and  frequently  repeated 
until  the  inflammatory  process  is  abated. 

The  employment  with  the  local  hot  air  apparatus  over  in- 
flammatory regions  in  the  pleural  and  abdominal  cavities,  is  an- 
other efficient  method  of  applying  convective  heat  in  these 
cases.  The  patient,  reclining,  is  placed  near  the  edge  of  the 
bed,  with  the  side  or  surface  involved  directed  towards  the 
open  side  of  the  apparatus..  The  surface  to  be  treated  is  then 
wrapped  with  two  or  three  layers  of  Turkish  toweling  and 
the  hood  of  the  apparatus  is  brought  to  the  surface  in  such 
a  manner  as  to  convey  the  heat  to  the  affected  area;  by  this 
means  temperatures  ranging  from  300°  to  400°  F.  may  be 
administered  for  as  long  a  period  as  indicated,  usually  for 
from  twenty  minutes  to  one-half  hour. 

Another  method  of  employing  convective  dry  heat  in  con- 
nection zvith  cold  applications  will  prove  invaluable  in  some 
subacute  inflammatory  processes,  or  abdominal  hyperemia, 
as  follows.  In  congestion  of  the  large  glands,  the  liver  and 
spleen,  for  example,  associated  with  a  low  grade  general 
metabolism,  the  application  of  heat  to  the  lower  portion  of  the 
trunk  and  limbs,  by  means  of  several  gallons  of  boiling  hot 
water  in  receptacles,  wrapped  in  flannel  cloths  and  placed  upon 
the  blankets  upon  which  the  patient  reclines,  and  then  with 
all  the  lower  abdomen  and  lower  extremities  enveloped  in 
blankets,  cold  compresses  at  a  temperature  of  60°  F.,  and  fre- 
quently changed  are  applied  over  the  involved  glands.  This 
method  will  be  found  also  invaluable  in  cases  of  reversed 
peristalsis,  when  occurring  in  connection  with  post-operative 
vomiting.  The  happiest  result  in  a  condition  of  this  kind  was 
effected  in  the  writer's  family  at  the  suggestion  of  Dr.  Morris 
W.  Brinkmann,  of  New  York,  and  its  value,  well  attested  by 
the  prompt  relief  afforded  after  three  days  of  stercoraceous 
vomiting. 

The  use  of  hot  douches  for  rectal  and  colonic  flushings,  and 
the  treatment  of  pelvic  cellulitis  per  vaginam,  which  is  cordially 
recommended  as  instituted  by  Dr.  Thomas  Addis  Emmett,*  is 
a  means  of  conveying  convective  heat  into  the  cavities  of  the 
body,  which  has  proved  extremely  efficient  in  the  class  of  cases 

*  Principles  and  Practice  of  Gynecology,  3d  edition,  page  113. 


io8  CONVECTIVE  HEAT 

in  which  it  is  indicated.  The  correctness  of  the  technique  em- 
ployed in  these  cases  is  of  the  utmost  importance.  It  should 
be  borne  in  mind  (i)  that  the  treatment  is  for  the  purpose 
of  the  convective  application  of  moist  heat  to  inflammatory  con- 
ditions; (2)  that  a  temperature  should  be  maintained  at  as 
high  a  degree  as  can  be  tolerated  (from  108°  to  115°  F.) ; 
(3)  that  it  should  be  administered  to  the  patient  with  the  hips 
elevated,  with  the  employment  of  a  proper  douche  pan;  and  (4) 
that  the  flow  should  be  retarded  and  the  time  of  the  adminis- 
tration be  made  from  thirty  minutes  to  one  hour,  the  quantity 
of  water  employed  being  the  secondary  consideration,  the 
time  element  and  temperature  being  the  elements  of  greatest 
importance.  In  congestion  associated  with  infection,  a  hot 
douche  will  prove  of  the  greatest  service  at  the  bedside,  but 
will  not  compare  in  value  with  the  employment  of  the  static  and 
high  frequency  currents  in  inflammatory  conditions,  using 
the  static  wave  current  or  the  direct  vacuum  tube  current  in 
non-infected  cases,  or  the  high  frequency  currents  or  the  x-ray 
in  infected  cases. 

In  cases  of  general  septic  infection  following  a  condition  of 
localized  infection,  the  employment  of  the  body  hot  air  applica- 
tions at  temperatures  varying  from  250°  to  350°  F.,  the  patient 
properly  wrapped  in  Turkish  toweling,  as  previously  described, 
offers,  we  believe,  one  of  the  greatest  possibilities  of  controlling 
those  generally  fatal  conditions  of  any  means  yet  employed. 
The  light  bath  employing  the  combined  effects  of  radiant  light 
and  convective  heat,  from  accumulation  of  heat,  in  the  cabinet, 
may  serve  an  equal  or  better  purpose  in  such  cases,  in  accord- 
ance with  the  physiological  effects  upon  phagocytosis  and  ac- 
tive elimination  and  stimulation  of  the  reflex  centers,  all  of 
which  tend  to  raise  the  opsonic  index  and  increase  of  the 
body  energy. 

The  treatment  of  localised  septicemia  in  the  extremities 
offers  an  efficient  means ;  and  a  greater  boon  to  humanity,  is 
hard  to  find  than  the  employment  of  convective  dry  heat  in 
these  cases,  with  the  proper  local  apparatus  capable  of  em- 
ploying temperatures  of  200°  to  400°  F.  In  these  cases  it  is 
always  necessary  to  open  up  and  drain  all  collections  of  pus, 
when  the  subsequent  daily  applications  of  dry  heat  in  the  man- 
ner described  will  effectually  terminate  the  infectious  process 
in  all  cases  within  a  few  days,  three  usually  sufficing. 


Plate  VIII.— Treatment  of  Leg  and  Thigh  with  Local  Betz  Dry  Hot  Air 

Apparatus. 


THERAPEUTICS  OF  CONVECTIVE  HEAT      109 

In  cases  of  remote  acute  congestion,  as  in  lesions  of  the  spinal 
cord,  or  liver,  it  may  be  desirable  to  stimulate  the  vasculariza- 
tion  of  the  skin  in  order  to  drive  as  much  as  possible  of  the 
blood  from  the  deep  processes  into  the  skin.  In  these  cases, 
the  employment  of  the  body  hot  air  bath,  or  at  the  bedside 
by  placing  many  gallons  of  hot  water  in  receptacles  wrapped 
in  flannel  cloths  about  the  patient  in  bed  and  over  all  placing 
several  blankets,  is  effective.  By  this  means  a  temperature  of 
200°  may  be  maintained  for  the  desired  length  of  time,  vary- 
ing with  the  conditions  under  treatment. 

The  treatment  of  non-infectious  inflammatory  conditions, 
by  the  employment  of  convective  moist  or  dry  heat,  is  of  com- 
paratively little  efficiency  except  in  the  early  stages  of  such 
congestion.  While  it  may  relieve  pain  temporarily  by  lessen- 
ing tissue  and  vascular  tension,  it  will  fail  to  remove  the  ex- 
isting condition  of  stasis  with  the  associated  tissue  infiltra- 
tion and  induration,  and  consequently  fail  to  effect  complete 
relief  of  the  condition.  This  has  been  amply  demonstrated  in 
the  treatment  of  synovitis,  sprains,  and  contusions  which 
promptly  yield  to  the  administration  of  the  static  current. 
When  these  means,  however,  are  not  at  hand,  in  the  early 
stage  of  trauma,  the  judicious  employment  of  heat,  preferably 
dry  heat,  in  connection  with  strapping,  is  often  effective,  but 
not  so  promptly  as  applications  of  static  currents  and  sparks. 

For  defective  general  metabolism  associated  with  gout, 
rheumatism,  and  auto-intoxication — the  forerunners  of  arterio- 
sclerosis,— the  frequent  administration  of  convective  dry  heat 
or  radiant  and  convective  light  and  heat  administrations  in 
the  light  bath,  are  measures  demanding  the  most  urgent  rec- 
ommendation ;  for  by  acting  reflexly  upon  the  centers  govern- 
ing the  functions  of  excretion  and  elimination  of  the  skin, 
kidneys,  and  other  emunctories,  they  exercise  a  most  valuable 
influence  in  quickening  metabolism  and  promoting  an  elimina- 
tion of  waste  products  and  toxins  from  the  body,  and  together 
with  regulated  exercise  and  diet,  and  avoidance  of  such  things 
as  aggravate  the  conditions,  influence  a  restoration  of  the  nor- 
mal physical  conditions  of  metabolism  to  a  degree  readily 
appreciated.  Administrations  are  to  be  made  during  the  course 
of  treatment,  two  or  three  times  weekly,  for  two  or  three 
months,  or  until  the  conditions  of  arterial  tension  and  the  char- 
acter of  the  secretions  eliminated,  indicate  a  restoration  to 


i  io  CONVECTIVE  HEAT 

normal  of  the  functions  generally.  Convective  dry  heat,  or 
radiant  light  and  heat,  always  administered  in  conjunction  with 
auto-condensation,  alternated  with  the  constitutional  adminis- 
tration of  the  static  wave  current,  is  remarkably  efficacious 
in  lowering  high  arterial  tension,  and  preventing  farther  de- 
structive or  calcareous  changes  in  the  muscular  coats  of  the 
arterioles,  thereby  warding  off  or  preventing  a  dangerous  de- 
gree of  arteriosclerosis. 

The  above  observations  are  readily  appreciated  by  those  who 
have  become  familiar  with  the  employment  of  physical  agents, 
but  as  will  be  suggested  throughout  this  series,  it  is  evident  to 
the  trained  medical  mind  that  the  greatest  results  in  therapeu- 
tics are  to  be  obtained  not  from  the  employment  of  any  one 
physical  agent,  but  by  the  intelligent  employment  of  each,  in 
combination  with  others,  as  indicated  to  best  meet  the  con- 
ditions presenting. 


INDEX 


Absorption  induces  heat,  22 

Acne  rosacea,  68 

Actinic  effects  of  light,  23 

of  radiant  light,  74 

Action  of  Roentgen  ray  on  germ 

life,  56 

Activity  essential  to  health,  17 

Adenitis,  tubercular,  treatment  of, 
61 

Administration   of   light   bath,   47 

Alopecia  areata,  68 

Anal  conditions  treated  by  arc 
light,  62 

Anemia,  pernicious,  78 

Antiphlogistine,  application  of,  94- 
101 

Arc   light,   advantages   of,   26 

and  incandescent  lamps  com- 
pared, 26 

bath,  36 

,  disadvantages  of,  26 

in    nasal    and    throat    condi- 
tions, 62 

in  treatment  of  cavities,  62 

in  treatment  of  impetigo,  71 

in     treatment     of     pityriasis 

versicolor,  71 

in  treatment  of  prurigo,  71 

,  objections  to,  25 

rich  in  ultra-violet,  26 

Areas,  circumscribed,  treated  with 

smaller  lamps,  45 

Arterial  tension,  high,  treatment 
of,  48 

Arteriosclerosis,    controlled,    78 

,  dry  heat  as  a  preventive 

measure,  109 

,  treatment   by   dry   heat,    1 10 

,  treatment  of,  77 

Arthritis,  gonorrhea!,  observation 
on,  76 

,  infectious,  treatment  of,  76 

,  tubercular,  x-ray  and  high 

frequency  treatment  of,  60 

Artificial  sources  of  radiant  en- 
ergy, 25 

Atonic   skin  conditions,  64 

Auto-condensation  after  light  bath, 

47 

Auto-intoxication,  dry  hot  air  in 

treatment  of,  109 
,  light  baths  in,  48 


Bath,  hot  water,  application  of, 
94-102 

,  moist  steam,  94-101 

,  Turkish,  94-102 

Bier  and  advocates  do  not  recog- 
nize phagocytosis,  54 

on  treatment  by  hyperemia, 

54 
Blood,  effects  of  radiant  light  on, 

74 

not  affected  by  Roentgen  ray 

when  localized,  54 

stream  heated  by  radiant  en- 
ergy, 40 

Body  hot  air  apparatus,  action  of 
heat  in,  98 

temperature  dependent  upon 

radiation,  22, 

temperature,  effects  of  dry 

heat  on,  97 

Brinkmann,  Dr.  Morris  Weil, 
107 

Brush  discharge,  static,  in  treat- 
ment of  phlebitis,  61 

Buccal  cavities  treated  by  arc 
light,  62 

Cabinets,  light  bath,  33 
Carbuncles,  treatment  of,  60 
Cases    of   varicose    ulcer   treated, 

65 
Centers,    deep    spinal,    effects    of 

radiant  light  and  heat  on,  74 
Chemical  processes  produce  heat, 

22 

Chemotaxis,  effects  of  dry  heat 
on,  97 

,  positive,  demands  oxygen,  54 

,  positive,  influenced  by  light, 

23 

,  radiant  light  and  heat  in,  56 

Choice  of  incandescent  lamps  in 
treatment,  45 

Classification  of  simple  inflamma- 
tions, 49 

Cleaves,  Dr.  Margaret  A.,  61-62 

Colonic  flushings,   107 

Color  defined,  21 

production,  18 

Confinement,  effects  of,  79 
Congestion,    treatment    with    dry 

heat,   109 


112 


INDEX 


Constitutional  or  general  treat- 
ment, 46 

treatment  with  lamps  of  high 

c.p.  preferred,  45 

Convective  equalization  of  heat, 
40 

heat,  advantages  of,  76 

,  Oilman  Thompson's  experi- 
ments with,  93 

in  contradistinction  to  radi- 
ant heat,  93 

,  indications    for    employment 

of,  104 

,  induces  phagocytosis,  96 

,  influence  of  elimination,  76 

,  local   applications   of,   95 

,  methods   of   applications   of, 

94 

heat,     physiological     actions 

of,  295 

in  suppurative  tonsilitis,  104 

vs.   radiant   energy   in   otitis 

media,  59 

Convergent  reflections,  dark  spots 
beyond  focus  in,  20 

Crookes  tube,  25 

,  penetration  of  rays  from,  81 

Crothers,  Dr.  T.  D.,  77 

Curatulo  on  the  uses  of  photo- 
therapy in  obstetrics,  61 

Cystitis,  treatment  by  high  fre- 
quency currents,  57 

,  treatment  by  radiant  energy, 

56 

,  treatment  by  x-rays,  57 

Danger  of  radiant  energy  small, 
15 

Dark  spots  of  parabolic  lamps,  20 

Delbers  reports  of  lumbago 
treated,  52 

Derivative  effects  of  radiant  light 
and  heat,  42 

Dermatitis  or  blistering  rarely  oc- 
curs from  incandescent  radia- 
tions, 46 

Dermatology,  radiant  energy  in, 
64 

Desloges,  Dr.,  ovaritis,  treatment 
by  white  light,  61-70 

Dickson,  Dr.  C.  R.,  on  use  of  iron 
electrode  arc,  71 

Diosurio's  treatment  by  light  and 
high  frequency  currents,  62 

Douches,   hot,    107 

,  vaginal,  in  cellulitis,  107 

Dry  heat,  action  of,  on  chemio- 
taxis,  97 

,  action  of,  on  localized  in- 
fection, 98 

,  action  of,  on  metabolism,  97 


Dry  heat,  application  by  hot  water 
bags,  94-101 

,  application  of, 

,  a  preventive  measure  in  ar- 
teriosclerosis, 109 

,  body,  in  treatment  of  gout, 

199 

,  body,  remarkable  effects  of, 

97 

by  Turkish  baths,  94-101 

,  comparison  with  light  bath, 


,  convective,      ineffective      in 

deep-seated  conditions,   106 

,  convective    in    treatment    of 

localized   septicemia,    108 

,  effects  of  application,  94-100 

,  effects  of  perspiration  from, 

97 

,  effects  on  temperature,  97 

,  effects  on  toxemia  97 

,  hyperemia   induced  by,  94 

in  felons  or  whitlows,  105 

in  mastoiditis,    105 

in    treatment    of    furuncles, 

105 

in  treatment  of  non-infected 

inflammation,  109 

,  methods  of  applying,  104 

,  not  affecting  stasis,   109 

Dry  hot  air  in  treatment  of  auto- 
intoxication, 109 

in  treatment  of  rheumatism, 

109 

Eczema,    moist,   of   hands,   treat- 
ment of,  70 
treated  by  radiant  energy,  70 

treated  by  radiant  light  and 

heat,  70 

treated  by  static  brush  dis- 
charge, 70 

Effects,  extreme,  of  normal  radi- 
ations, 17 

of  absorption  of  colored  in- 
candescent bulbs,  22 

Effleuvation  instead  of  Finsen 
method,  46 

Effleuve  high  potential  in  atonic 
skin  conditions,  64 

Elimination  induced  by  radiant 
light  and  heat,  42 

through  emunctories  induced 

by  radiant  light  and  heat,  75 

Emmett,  Dr.  Thomas  Addis,  95- 

107 
,  Dr.  Thomas  Addis,  on  heat 

effect,  94-102 
Emmett's,  Dr.,  work,  96 
End    organ,    stimulation    of,    by 

radiant  light  and  heat,  74 


INDEX 


Energy  effects  activity  of  func- 
tion, 16 

Errors  of  terminology,  21 
Excretory  channels  awakened  by 
radiant  energy,  40 

Felons  or  whitlows  treated  by  dry 

heat,    105 

,   treatment  of,  60 

Fever    and    the    vis    medicatrix 

naturae,  97 
Finsen  and  contemporaries  sought 

reaction,  41 

apparatus,  29 

apparatus,  use  of,  69 

method  generally  superseded, 

46 

method,  local,  for  treat- 
ment of  lupus,  46 

,  Niels,  29-67 

Flannel  pads  for  application  of 
dry  heat,  94-101 

Fluorescence,  18 

,  induction  of,  21 

of  higher  frequencies,  15 

Forms  of  radiant  energy,  15 
Frequencies,    higher,    how    mani- 
fested, 15 

,  relative  effects  of,  81 

Frequency  and  relation  of  wave 
length,  18 

,  rates  of,  18 

Fulguration  of  Keating  Hart,  46 
Furuncles  treatment  by  dry  heat, 

105 

,  treatment  of,  60 

Furunculosis    treated    by    radiant 

light  and  heat,  71 

Germ  activity  inhibited  by  Roent- 
gen ray,  54 

life,    ultra-violet    action    on, 

4i 

processes,   radiant  light   and 

heat  in,   56 

Germs  inhibited  by  heat,  54 

inhibited     by     radiant    light 

and    heat,    74 

Gilman  Thompson,  Dr.,  experi- 
ments with  convective  heat,  93 

,  observations  by,  106 

Glass  cuts  out  ultra-violet  fre- 
quencies, 17 

Goerl  lamp,  32 

Gonorrheal  conditions,  radiant 
energy  in,  55 

Gout,  use  of  dry  heat  in,  109 

Grad,  Dr.  Herman,  97 

Health,  essential  to  maintenance 
of,  17 


Heat  and  cold,  combined  applica- 
tion of,   107 

applications,  principles  of  in- 
dication, 94 

convective,  local  uses  of,  104 

,  evolution  of,  by  radiant  en- 
ergy, 16 

induced  by  absorption,  22 

production,   18 

rays,  infra-red,  22 


rays,  maximum  intensity  of, 

22 

Helmholtz,  80 

Hewitt,  Cooper,   lamp,  32 

High   c.p.   incandescent   lamp   for 

constitutional  treatment,  46 
Higher     frequencies,     effects     on 

races,  23 

frequencies,  hyperemia  of,  23 

frequencies,  unimportant,  41 

High  frequencies,  effects  upon  the 

tissues,  16 

High  frequency  currents,  effects 
of,  on  germ  life,  56 

in  cystitis,  57 

induce  hyperemia,  56 

in   treatment   of  eczema,    70 

in    treatment    of    tubercular 

arthritis,  60-61 

produce  actinic  and  antisep- 
tic effects,  56 

High    frequency    replaces    Finsen 

method,  46 
Hot  air  apparatus,  body  or  local, 

94 

apparatus,  local  employment 

of,   107 

,  body,  in  septic  infections,  108 

Hot  box,  94-103 

Hot   douche,   applications  of,   94- 

102 
Hot  water  bag,  application  of,  94- 

101 

bags   for  application  of  dry 

heat,  94-101 

Human  tissue,  how  affected  by 
radiant  energy,  22 

Hyperemia  as  influencing  inflam- 
matory conditions,  53 

by  high  frequency  currents, 

55 

,  effects  of,  41 

,  effects  on  infection,  97 

favors  local  nutrition,  24 

from  higher  frequencies  con- 
sidered, 23 

from    ultra-violet,    irritating, 

45 

,  general  effects  from,  74 

general  or  local,  induced  by 

radiant  light  and  heat,  74 


INDEX 


Hyperemia,  important  effect,  41 

increased    by   high   potential 

high  frequency  currents,  64 

induced  by  dry  heat,  94 

induced    by    radiant    energy, 

24 

in  the  treatment  of  infection, 

53-96 

modus  operandi  in  treatment 

of  infection,  53 

treatment  by,  a  principle,  55 

Hyperidrosis  pedis,  x-ray  in,  17 
Hypertention,    effects    of    radiant 

light  and  heat  on,  77 

in  arteriosclerosis,  77 

Impetigo  treated  by  arc  light,  71 
Incandescent  lamp,  25 

lamp  and  arc  light  compared, 

26 

lamp  preferable  in  treatment 

of  local  infections,  44 

lamps,  advantages  of,  26 

lamps,   choice    of,    in    treat- 
ment, 45 

lamps,  disadvantages  of,  26 

lamps  of  high  candle  power, 

29 

— —  lamps  of  high  candle  power 
in  auto-intoxication,  48 

lamps  of  high  candle  power 

in  plethora,  48 

lamps  of  high  candle  power 

preferred       for       constitutional 
treatment,  45 

lamps  of  lower  candle  power, 

31 

lamps    smaller,    for   treating 

circumscribed  areas,  45 

lamps,  types  of,  29 

light  bath,  35 

light    in    the    treatment    of 

eczema,  69 

light,  post-operative  uses  of, 

61 

Indications  for  employing  convec- 

tive  heat,  104 
Infection,  effects  of  hyperemia  on, 

97 

general,  elimination  of  tox- 

ines  in,  76 

,  Roentgen    ray    in    treatment 

of,  55 
.treatment  by  hyperemia,  53- 

96 
Infectious   inflammations,   radiant 

energy  in,  53 

processes,      radiant      energy 

effective  in,  41 

Inflammation,  non-infected,  treat- 
ment by  dry  heat,  109 


Inflammations,  infectious,  com- 
pared, 49 

,  local  methods  of  treatment, 

51 

,  non-infectious  compared,  49 

Inflammatory  conditions,  plural 
and  abdominal,  convective  dry 
heat  in,  105 

Infra-red  heat  rays,  22 

Infra-red  not  "light,"  21 

Inhibitory  action  of  Roentgen  ray, 
56 

Iritis,  post-operative,  treatment  by 
light,  63 

Iron  electrode  arc  in  the  treat- 
ment of  skin  diseases,  71 

Kaolin,  application  of,  94-101 
Keating  Hart,  Dr.,  46 

Lamp  for  intestinal  treatment,  61 

,  Goerl,  32 

,  leucodescent,  32 

,  mercury  vapor,  32 

,  small  incandescent,  32 

,  uviol,   32 

Lartet  and  Genoud  lamp,  29 
Law  of  harmony  of  vibration,  16 
Lesser  of  Berlin,  reports  of  light 

treatment,  68 
Leucocythemia,  78 
Leucodescent  lamp,  29 
Leukemia,  78 
— - — ,  x-ray  effects  in,  86 
Light,  actinic  action  of,  54 

and  heat,  methods  of  appli- 
cation of,  44 

applications    always    general 

as  well  as  local,  40 

bath,   administration  of,   47 

,  after  treatment,  47 

a  prophylactic  measure,  79 

,  arc,  36 

as  substitute  for  hot  box,  94 

cabinets,  23 

cabinets,  Betz,  38 

cabinets,  construction  of,  34 

cabinets,    Kny-Scheerer,    38 

cabinets,  special  types  of,  37 

cabinets,  types  of,  33 

cabinets,  upright,  38 

cabinets,  writer's,  37 

,  comparison  with  dry  heat,  76 

,  duration  of  treatment,  47 

followed    by    auto-condensa- 
tion, 47 

followed  by  static  treatment, 

47 

followed   by   vibration,    47 

for  constitutional   treatment, 

46 


INDEX 


Light  in  auto-intoxication,  48 
,  incandescent,  35 

in    high   arterial   tension,   48 

in  obesity,  48 

in  the  household,  79 

,  reclining,  35 

— ,  temperature  with,  47 
,  water  given  ad  libitum  with, 

48 

Light,  chemical  actions  of,  23 
,  counter  effect  to  x-ray,  88 

dependent       upon       radiant 

energy,  22 

not     effective     in     relieving 

local  stasis,  50 

treatment,  reports  of,  69 


Local  administrations,  the  methods 
of,  45 

applications,  effects  not  local 

only,  41 

inflammation,       incandescent 

lamp  preferable  in,  44 

influences    of    radiant    light 


and  heat,  41 
Localized  infection,  action  of  dry 

heat  in,  98 

Local  nutrition,  favored  by  induc- 
tion of  hyperemia,  24 
Lodge's  conception  of  the  x-ray, 

80 

Lodge,  Sir  Oliver,  80-81 
London  hospital  lamp,  29 
Lumbago,    cases    reported,    52 

differentiation  of  types,  52 

radiant    light    and    heat    in, 

52 

Lumbar    arthritis,    differentiation 

from  lumbago,  52 
Lupus,      and      allied      conditions, 

treatment  of,  67 
,  cases,  reports,  and  results,  68 

erythematosus,      reports      of 

cases,  68 

erythematosus,   treatment   of 


by  iron  electrode  arc,  72 
Lymphatics,     effects     of     radiant 
light  and  heat  on,  74 

Makarejev  on  the  uses  of  white 
light  in  pelvic  conditions,  61 

Marine  search  light,  27 

Mastoiditis,  in  the  early  stage  of, 
105 

radiant  energy  in  treatment 

of,    59 

x-ray  in  treatment  of,  59 


Mechanical  vibration,  comparison 

with  radiant  energy,   17 
Mercury  vapor  lamp,  25-32 
vapor   lamps   cut  out    ultra- 
violet, 17 


Mercury  vapor  lamps,  employment 

of,  26 
Metabolism,   effects   of   light   and 

heat   on,   24 
,  effects  of  radiant  light   and 

heat  on,  42 
-,  end     organ,     stimulated 


radiant  light  and  heat,  78 
— ,  faulty,      treatment      of, 


by 

by 

radiant  light  and  heat,  78 
— ,  general   effects   of   dry   heat 
on,  109 

increased  by  dry  heat,  97 


Metchnikoff's  phagocytosis,  53 
Minin  light,  30 

Prof.,  30 

Molecular   motism    induced,    16 
Moller   of   Stockholm,   reports   of 

cases,  68 
Moist  heat,  methods  of  applying, 

94-100 

— ,  principles  of  applying,  94 
Morris'    and    Dove's    reports    of 

cases,  68 

Munday,  Dr.  Bert,  97 
Muscular    soreness,    radiant    light 

and  heat  in,  52 
Myalgias,   radiant   light  and   heat 

in,  51 

Nasal  'conditions    treated    by    arc 

light,  62 
Natural  sources  of  radiant  energy, 

25 
Nature,   object  of  ultra-violet  in, 

23 
Nephritis,  radiant  light  and  heat 

in,  75 
Neurons,     peripheral,     effects     of 

light  on,  24 
Nevus,  vasculosis,  68 
Niels,      Finsen's      demonstrations 

concerning  ultra-violet,  41 

Objection  to  ultra-violet  frequen- 
cies, 17 

On  actions  of  heat,  95 
Opposite   effects   of   radiant   light 

and  heat  and  the  x-ray,  80 
Orloff  of  Russia,  61 
Otitis  media,  abortion  of,  57 

,  case,  report  of  treatment,  59 

,  chronica,  x-ray  in,  59 

,  indications  for  treatment  of, 

,  treatment  by  convective  heat, 


105 
,  treatment     of,     by     radiant 

energy,  59 
Ovary,  congested,  treated  by  white 

light,  61 


u6 


INDEX 


Oxidation  by  light,  23 

radiant  light  and  heat  in,  56 

Oxidizing    influences    of    radiant 

light,  74 
Oxygen,  demand  of,   for  positive 

chemotaxis,  54 
Ozena     treated     by     incandescent 

light,  62 

treatment  by  light  and  high 

frequency  currents,  62 

Pain  relieved  by  radiant  light,  50 
Parabolic  reflections  produce  dark 

spots,  20 
Parenchymatous  nephritis,  radiant 

light  and  heat  in,  74 

,  treatment   of,   75 

Pelvic    conditions,    treatment    by 

white  light,  61 

congestions,  treatment  of,  61 

Penetration  of  radiant  energy,  40 
Peritonitis,  treatment  by  dry  heat, 

106 
Perspiration,  induced  by  dry  heat, 

97 
,  induced    by    radiant    energy, 

24 
Phagocytes,   locally   increased   by 

hyperemia,  41 
Phagocytosis,  induced  by  convec- 

tive  heat,  96 

Phlebitis,   treatment  of,   61 
Physical  characteristics  of  radiant 

energy,    18 
characteristics   of   the   x-ray, 

81 

properties,  relation  to  thera- 
peutics, 22 

Physiological  actions  of  the  x-ray, 
82 

effects  of  convective  heat,  95 

effects  of  radiant  light  and 

heat,  40 

Pick  and  Asahi  of  Prague,  reports 
of  cases  treated  by,  69 

Pitcher,  Dr.  Herbert  R,  on  mas- 
toiditis,  and  otitis  media,  59-60 

Pityriasis  versicolor,  treatment  of, 
by  concentrated  arc  light,  71 

Platino,  barium  cyanide  fluoresces, 
15 

Plethora,  treatment  of,  48 

Pleurisy,  treatment  of,  by  dry 
heat,  106 

Polarization,  18-21 

Post-operative  uses  of  incandes- 
cent light,  62 

Races,  color,  comparison  of,  23 
Radiant  energy,  affecting  chemo- 
taxis, 23 


Radiant    energy    compared    with 
the  coarser  vibrations,  17 
,  comparison     of     forms     of, 


16 
88 


counter     effects     to     x-ray, 

,  effects  of,  40 

-  effects  on  human  tissue,   18 

-  effects   upon  metabolism,   42 

-  ,  elimination  induced  by,  24 

-  essential  to  light,  22 

-  ,  forms  of,  15 

-  ,  forms   of,   congeners,   57 

-  ,  frequencies  variable,  15 

-  ,  importance  of  technic  in,  15 

-  in  cystitis,  56 

-  in  dermatology,  64 

-  induces  hyperemia,  18 

-  in  germ  processes,  55 

-  gonorrheal  infection,  55 

-  inhibits  germ  activity,  54 

-  in  infectious  conditions,  53 

-  in    otitis     media,     chronica, 

59 

-  in  streptocpccic  and  staphy- 
lococcic  infection,  55 

-  in  treatment  of  eczema,  70 

-  in   treatment   of  mastoiditis, 


59 
59 


in  treatment  of  otitis  media, 


in  tubercular  infection,  55 

,  little  danger  of,  15 

,  penetration  of,   18-40 

-,  physical     characteristics     of, 


18 


55 


projected,  93 
-,  relative  effects  of,   16 
-,  sources  of,  16 
-,  specialized    employment    of, 

5 

-,  tanning  of  the  skin  by,  23 

,  summarized,  56 

,  value  of,  as  a  curative  agent, 

15 

vs.  convective  heat  in  otitis 

media,  59 

Radiant    heat    and    radiant    light 

compared.  17 
Radiant   light,   actinic   effects   of, 

74 
Radiant  light  and  heat,  action  of, 

56 

and  the  Roentgen  ray,  oppo- 
site effects  of,  8q 

,  characteristics  of,  81 

derivative  effects,  42 

-,  duration   of  applications   of, 


45 


-,  effects   of,  81 

-  effects  on  hypertension,  77 


INDEX 


117 


Radiant  light  and  heat  effects  on 
deep  spinal  centers,  74 

effects  on  lymphatics,  74 

effects   on  simple   inflamma- 
tion, 42 

favorable   to  positive   chem- 

otaxis,  54 

for  constitutional  treatment, 

46 

from  incandescent  lamps  no 

blistering  or  dermatitis,  46 

hyperemic  effects  of,  41 

in  atonic  skin  conditions,  64 

in  chemotaxis,  56 

in    conditions   of  poor   met- 
abolism, 78 

in      conjunction      with      the 

Roentgen  ray,  64 

in  faulty  metabolism,  74 

in  germ  processes,  56 

in  infectious  conditions,  42 

,  inhibition  of  germ  life  by,  55 

in  myalgias,  51 

in  nephritis,  75 

in  otitis  media,  57 

on  oxidation,  56 

in  parenchymatous  nephritis, 

75 

interchangeable,  18 

in  traumatic  injury,  42 

in    treatment    of   carbuncles, 

60 

in  treatment  of  eczema,  70 

in  treatment  of  felons,  60 

in  treatment  of  furuncles,  60 

in  treatment  of  furunculosis, 

in    treatment    of    lupus    and 

allied   conditions,   67 

in  treatment  of  phlebitis,  61 

in  treatment  of  suppurating 

ulcers,  67 

in  treatment  of  suppurating 

tonsilitis,  60 

in    treatment    of    tubercular 

arthritis,   61 

,  local  administration  of,  44-45 

,  local   influences   of,   41 

,  observation  on  effects,  75 

,  physiological   effects  of,   40 

,  postoperative  uses  of,  50 

,  preferable  in  local  infections, 

55 

,  reflex  effects  of,  74 

,  sudorific  action  of,  77 

,  thermic  effects  of,  74 

Radiant    light    and    radiant    heat 

compared,    17 

Radiant  light,  effects  on  blood,  74 
,  effects  on  faulty  metabolism, 

74 


Radiant  light,  effects  on  pain,  50 

,  oxidizing   influences   of,   74 

,  post-operative  uses  of,  after 

eye  operations,  63 

Radiations,  comparative  rates  of 
vibration  of,  18 

,  effects  upon  tissue  of,  22 

,  extreme  effects  of,  17 

Radium  and  Roentgen  ray  over- 
whelm tissues,  16 

Rates  of  vibration,  varying  effects 
of,  17 

Reaction  from  ultra-violet  sought, 
4i 

Rectal  flushings,   107 

Reflexes  of  peripheral  stimulation, 
24 

Reflections  parallel,  20 

Refraction   defined,    18 

illustrated,  18 

of  radiant  energy,  18 

Reports    of   eczema    treated    with 

high  frequency  currents,   70 

light  treatment,  71 

Rheumatism,  dry  hot  air  in  treat- 
ment of,  109 

Rheumatoid  arthritis,  78 
Rieder  of  Munich,  67 
Riviere,   Dr.  J.  A.,  46 
Roentgen  ray,  action  on  germ  life, 
56 

and   radium  overwhelm  tis- 
sues, 16 

,  effect  upon  blood,  54 

,  employment  of,  in  infection, 

56  . 

inhibits  germ  activity,  54 

in  infected  skin  diseases,  64 

in   treating   infection,    55 

,  sterilizing  effects  of,   56 

Russell's  reports  of  lumbago,  52 
Russian  baths,  94,  100,  101 

Schamberg,  reports  of  cases,  69 
Senses,  response  to  radiant  energy, 

15 
Septicemia,    localized    by    convec- 

tive  dry  heat,   108 
Septic  infection,  treatment  of,  77 
processes,  effects  of  dry  heat 

on,  96 
Simple    inflammation,    effects    of 

radiant  light  and  heat  on,  41 

inflammations,  classified,  49 

Solar  arc  lamp,  28 

Sources,  artificial,  of  radiant 
energy,  25 

of  radiant  energy,  25 

,  natural,  of  radiant  energy,  25 

Staphylococci  and  streptococci 
susceptible  to  x-ray,  57 


n8 


INDEX 


Staphylococcic  conditions,  radiant 

energy  in,   55 
Stasis,  local  light  not  effective  in, 

50 

not  affected  by  dry  heat,  109 

Static  brush   discharge   in   atonic 

skin  conditions,  64 

in  treatment  of  eczema,  70 

Static  treatment  after  light  bath, 

47 

Steiner  of  Leipzig,  reports  of 
cases,  71 

Streptococcic  conditions,  radiant 
energy  in,  55 

Sudorific  action  of  radiant  light 
and  heat,  77 

Summarization  of  use  of  radiant 
energy,  56 

Sun  light,  objections  to,  in  thera- 
peutics, 25 

Suppurating  ulcers,  light  treat- 
ment of,  60 

Suppurative  tonsilitis,  treatment 
of,  60,  104 

Surgery,  modern  uses  of  light  in, 

63 

Sweat  glands,  effects  of  radiant 
light  and  heat  on,  74 

Tanning  by  ultra-violet  a  natural 
protection,  17 

by  ultra-violet,  when  objec- 
tionable, 17 

of  the  skin  by  radiant  energy, 


23 

of  the  skin  objectionable  in 

therapeutics,  23 

prevents   further  penetration 

by  radiant  energy,   17 

Technique  important  in  radio- 
therapy, 15 

Terrde  reports  on  phototherapy, 
69 

The  actinolite,  28 

The  arc  lamp  solar,  28 

The  hot  poultice,  principles  of 
applying,  94-100 

Therapeutics  depending  upon 
physical  properties,  22 

Thermic  effects  of  radiant  light 
and  heat,  74 

The  Roentgen  ray  and  ultra-violet 
cause  fluorescence,  16 

The  sun  the  natural  source  of 
light,  25 

Thoroughness,  importance  of,  in 
physical  therapeutics,  44 

Titus,  Dr.  Edward  C,  experi- 
ments of,  87 

Tonsilitis,  suppurative,  treatment 
of,  104 


Torticollis,  radiant  light  and  heat 
in,  52 

Toxemia,  effects  of  dry  heat  on, 
98 

,  following  x-ray,  84 

,  general  indications  for  radi- 
ant light  and  heat  in,  76 

,  prevention  of,  77 

Toxines,  elimination  of,  following 
diphtheria,  76 

,  elimination      of,      following 

general  infection,  76 
-,  elimination      of,      following 


nephritis,  76 
-,  elimination    of,    by    radiant 


light  and  heat,  74 

Traumatic  injury,  radiant  light 
and  heat  in,  42 

Treatment  of  carbuncles  by  radi- 
ant light  and  heat,  60 

by  x-ray,  60 

Treatment    of    felons    by    radiant 

light  and  heat,  60 
Treatment  of  furuncles  by  radiant 

light  and  heat,  60 

by  x-ray,  60 

Treatment  of  simple  inflammation, 

49 
Treatment  of  suppurative  tonsilitis 

by  radiant  light  and  heat,  60 
Tubercular      conditions,      radiant 

energy  in,  55 
Tuberculosis,  x-ray  in,  57 
Tungstate   of   calcium   fluoresces, 

15 

Turkish  baths,  94-102 
,  administration   of,   94 

as  a  means  of  applying  dry 

heat,    94-101 

Turkish    toweling,    wrappings    in 

hot  air  treatment,  108 
Types  of  light  bath  cabinets,  33 

Ulcers,    suppurating,    light    treat- 
ment of,  67 
Ultra-violet,  absorbed  by  glass,  17 

,  action  on  germ  life,  41 

,  advantage  of  elimination  of, 

17 

,  arc  light  rich  in,  26 

,  fluorescence  of,  21 

,  not  "light."  21 

,  object  in  Nature,  23 

,  objections  to,  17 

radiations  irritating,  45 

rays  produce  fluorescence,  16 

,  tanning  effects  of,   17 

Uviol  lamp,  32 

Varicose  ulcers,  indication  for 
treatment  of,  65 


INDEX 


119 


Varicose  ulcers,  supportive  treat- 
ment of,  65 

,  treatment  of,  64 

Venous  hyperemia,  not  favorable 

to  positive  chemotaxis,  54 
Vibration,  effects  on  function,   16 

,  law  of  harmony  of,  16 

,  mechanical,    following    light 

bath,  47 

Walter,  Dr.,  70 

Water  administered  during  light 
bath,  48 

Wave  length  and  relation  of  fre- 
quency, 1 8 

White  light,  uses  of,  in  pelvic  con- 
ditions, 61 

Willemite  fluoresces,  16 

Winternitz,  experiments  with  sun 
light,  70 

Wright's  opsonic  indices,  53 

Writer's  method  of  treating  in- 
fection, 54 

X-ray  breaks  down  tissue,  83 

,  characteristics    of,    81 

,  cumulative  action  of,  84 

,  dermatitis  cause  of,  82 

dermatitis   not  analogous  to 

inflammation,  86 

,  effect  on  abnormal  tissue,  83 

,  effect  on  all  protoplasm,   83 

,  effects    on    congestion,    83 


X-ray,   effects  on  normal    tissue. 

93 

,  effects  on  pain,  82 

,  effects   upon  absorption,  87 

,  effects  upon  glandular  struc- 
tures, 87 

,  effects  upon  ovulation,  87 

,  effects   upon    seeds,   87 

,  fluorescence  of,  21 

,  hypothesis   of  action,   85 

,  in  cystitis,  56 

induces    contraction    of 

masses,  85 

induces    tissue    inertia,    84 

— ,  inhibitive   effects   of,   84 

in    hyperidrosis    pedis,    87 

in  leukemia,  86 

in  treatment  of  carbuncles,  60 

in    treatment    of    furuncles, 


60 


in   treatment  of  mastoiditis, 


59 


in    treatment    of    tubercular 
arthritis,  61 
—  in   tuberculosis,   57 

,  longitudinal  ether  vibrations, 


85 

,  not   ionization,  85 

,  producing  toxemia,  84 

,  replaces    Finsen    method,   46 

,  sterilizing   effects    of,   87 

,  stimulating  effects  of,  84 

,  wave   lengths   of,    18 


Date  Due 


APR  17 


1978 


PRINTED  IN   U.S.*.  CAT.     NO.     24     161 


'52 


* 

00041698^ 


WBU95 


1909  fS 

Snow,  William  Benham 

The  therapeutics  of  radiant  light  and  O 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92661 


